Background: Among oncological patients there is a group of patients with outcomes hard to predict because of few possibilities to diagnose, even though there are a lot of procedures, some of them being very painful. Absence of a diagnose lowers the chances of healing even before treatment starts, fact that makes patients refuse specific therapy. Often, these patients are referred to different medical centers during the short life that they have left. We are talking about patients in whom the clinical signs are metastasis; meanwhile the primary tumor doesn’t have any manifestations at all. Percutaneous biopsy of the spinal column is a minimal invasive and rapid technique that obtains tissue samples from the vertebral body, intradiscal regions and paravertebral regions. Despite progress of computed tomography and magnetic resonance imaging technologies, basic diagnosis of different pathologies of the spinal column remains difficult. In most of the cases, a tissue sample is needed to settle a clear diagnosis. Percutaneous biopsy is preferred over the open biopsy because of the low costs, morbidity and mortality. The aim of this article is to review and to highlight in details the efficiency of percutaneous biopsy, by pointing out its influence on the treatment and decisions in such branches like surgery, chemotherapy, radiotherapy depending on the morphological nature of the lesions. Conclusions: Percutaneous biopsy of the spinal column is the elective procedure in definitive diagnosis of pathological lesions.