Spinal Compression fractures are common and may occur as a result of benign or malignant processes. Benign Compression fractures may occur as a result of trauma, osteoporosis, Paget’s disease, other metabolic diseases, infection (especially atypical infections which may not involve the disk space), eosinophilic granuloma and benign primary bone tumors such as hemangioma. Malignant Compression fractures are most commonly encountered as a result of metastatic disease, multiple myeloma which is the most common primary bone tumor and leukemia. Rarely, malignant Compression fractures occur as a result of other malignant primary bone tumors.Differentiation of malignant and benign Compression fractures may be challenging. Both clinical findings and different imaging techniques are used for differentiation. This may be particularly difficult in elderly patients who are predisposed to benign Compression fractures caused by osteoporosis. In this group benign fracture may result from minor trauma and can make the interpretation of the lesion difficult, if there is a known primary malignancy elsewhere. Establishing the correct diagnosis is of great importance in determining treatment and prognosis. In many instances biopsy and tissue diagnosis are necessary for the final diagnosis. The following imaging techniques are utilized in the evaluation of benign and malignant spinal Compression fractures: radiography, computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, positron emission tomography (FDG-PET) and PET-CT.