Neck and back pain are frequent complaints of patients with pediatric cancer, second only to headaches as a cause of neurologic consultation. The importance of this symptom, however, has not been studied in the pediatric cancer patients. This report is a review of the consultations as a result of neck and back pain in patients with pediatric cancer, with analysis of clinical presentation, etiology, underlying cancer, and neuroradiologic findings. The etiology of the complaint varied with the underlying cancer, although metastatic disease to the spine was frequent in patients with solid tumors, in younger children, and in patients admitted to the hospital. Back or neck pain is a serious complaint in children with systemic cancer, because the incidence of metastatic disease is high. Magnetic resonance imaging of the whole spine should be obtained if metastatic disease can not be excluded clinically, particularly for young patients and in children with advanced disease.