The organ most commonly affected by metastatic cancer is the skeleton, and spine is the site where it causes the highest morbidity. Computer-aided diagnosis (CAD) for detecting and assessing metastatic disease in bone or other spine disorders can assist physicians to perform their decision-making tasks. A precise segmentation of the spine is important as a first stage in any automatic diagnosis task. However, it is a challenging problem to segment correctly an affected spine, and it is a crucial step to assess quantitatively the results of segmentation by comparing them with the results of a manual segmentation, reviewed by one experienced radiologist. This chapter presents the design of a MATLAB-based software for the manual segmentation of the spine. The software tool has a simple and easy to use interface, and it works with either computed tomography or magnetic resonance imaging (MRI). A typical workflow includes loading the image volume, creating multi-planar reconstructions, manually contouring the vertebrae, spinal lesions, intervertebral discs and spinal canal with availability of different segmentation tools, classification of the bone into healthy bone, osteolytic metastases, osteoblastic metastases or mixed lesions, being also possible to classify an object as a false-positive and a 3D reconstruction of the segmented objects.