As people become more health conscious and medical diagnostic techniques improve and become more widespread, more and more diseases are being detected early. Some people may find a growth on their spine during a routine physical exam, while others may find it as a result of a hospital visit for some medical condition. It is important not to panic when you find a “thing” on your spine and not to rush into treatment. The first step is to determine if the “thing” is abnormal. I have encountered many patients who have had an MRI at their local hospital and have mistaken a Modic change in the vertebral body for a tumor, resulting in a false alarm. If you are not sure, you can have a CT scan to see if there is any bone damage in the vertebral body. MRI and CT scans have their own focus, not which is expensive which is better, generally speaking MRI on soft tissue and nerve imaging clear, CT on bone imaging clear. The combination of the two can provide a comprehensive response to the presence or absence of destructive lesions in the vertebral body. Are all destructive lesions on the vertebral body tumors? Of course not. Infectious diseases of the spine can also manifest as destruction of the vertebral body. For example, tuberculosis or bacterial infection of the spine. In addition to pain, patients with spinal tuberculosis also tend to have symptoms such as low fever, fatigue, night sweats, and weight loss. Bacterial vertebral or intervertebral disc infections are associated with high fever and chills, and some patients have a history of puncture, surgery, or infection at other sites. Treatment of infectious lesions relies primarily on medications. Surgical treatment is considered only in cases of severe bone destruction resulting in fracture or compression of nerves causing neurological dysfunction. In recent years, the incidence of tumors has shown an increasing trend. Tumors occurring in the spine are divided into two major categories, one is primary tumors, i.e. tumors originating from bone tissue, such as giant cell tumor of bone. The other category is metastatic tumors, i.e. tumors that metastasize from other tissues and organs to the spine, such as breast cancer metastasis. There are many types of tumors occurring in the spine, and in terms of quantity, more than 90% of them are metastatic cancers. Although they have some individual imaging features, the accuracy of diagnosis by imaging alone, even for the most experienced imaging physicians, is hardly more than 60%; and this 60% accuracy is not enough to meet the need for treatment. This is because, whether it is an infectious lesion or a tumor, the treatment varies widely depending on its type. In contrast, CT-guided puncture to obtain the lesion tissue and pathological examination can obtain the most accurate diagnosis, with an accuracy rate of more than 90% in the period. As an example, the case of a 64-year-old man who was examined in the field due to neck pain and found to have a destructive C4 vertebral lesion and underwent a partial C4 vertebral resection locally, the postoperative pathology revealed a chordoma. Four years later, the patient suddenly developed quadriplegia and was found to have a recurrence of the tumor, which involved a wide area of the C2-4 vertebral body and caused severe compression of the spinal cord due to the invasion of the tumor into the spinal canal. After the patient was transferred to our hospital, we performed a total C2-4 laminectomy with a combined posterior-anterior approach to completely remove the tumor tissue, and no recurrence of the tumor has been seen for 4 years. Therefore, if you find a “thing” growing on the spine, you should not operate hastily. It is important to perform CT-guided puncture biopsy in addition to routine examinations such as X-rays, CT and MRI. Only after the nature and histological origin of the lesion are clearly identified can targeted treatment be started. Of course, there are exceptions to this rule. If progressive spinal cord dysfunction or paralysis is found along with the spinal lesion, the spinal cord compression should be removed surgically as soon as possible depending on the specific situation, while tumor tissue should be obtained intraoperatively to obtain an accurate pathologic diagnosis, and then the treatment plan should be adjusted according to the final pathologic diagnosis. Figure 4 shows such a case. After 2 months of pain in the thoracic back, the patient suddenly developed bilateral lower limb paralysis with muscle strength of 0-1. After coming to our hospital for examination, a T4 vertebral tumor was found, and the tumor invaded the spinal canal causing significant compression of the spinal cord. Since the patient’s spinal cord function was nearly lost, it was already too late to do CT-guided puncture, because it took about 10 days for the results of conventional puncture. We immediately performed PET/CT on the patient and found only one other tumor in the body, and other imaging suggested the possibility of “invasive hemangioma”. This is a benign tumor that is sensitive to radiotherapy. In order to quickly relieve the tumor from compressing the spinal cord and reduce surgical damage, we planned to perform posterior resection of the T3-5 lamina and intravertebral canal, while leaving the tumor tissue in the vertebral body for postoperative radiotherapy. We completed the decompression surgery as scheduled, and the muscle strength of both lower extremities was restored to about level 4 (out of 5) one week after surgery. The postoperative pathology indicated “highly differentiated hemangiosarcoma”, which is a low-grade malignant tumor, and complete surgical resection is the main treatment. In order to prevent the progression of the residual tumor after surgery, we then performed a total posterior T3-5 laminectomy, which removed all the tumor tissues in one fell swoop, while the patient’s neurological function was satisfactorily restored and he was able to walk on his own when he was discharged. Radiation therapy was continued 1 month after surgery. In conclusion, there is a wide variety of destructive lesions on the spine, and diagnosis by imaging alone is not reliable; definitive diagnosis depends on CT-guided puncture biopsy. It is important not to rush into surgery without obtaining an accurate pathological diagnosis.