In the past, radiotherapy or chemotherapy was mainly used for spinal metastases, and palliative resection was performed only when there were symptoms of neurological compression, i.e., partial resection of the tumor to relieve the neurological symptoms caused by tumor compression. Such a surgical approach has a high rate of postoperative tumor recurrence, and because the tumor is not completely removed, there is a lot of intraoperative and postoperative bleeding and surgical trauma, which makes it difficult for patients to tolerate the surgery. In view of this, many scholars are still more conservative in dealing with metastatic tumors of the spine. However, with the improvement of modern tumor diagnosis and treatment technology, the five-year survival rate of patients with many types of tumors has improved greatly. In case of spinal metastases, patients may still survive with tumors for a longer period of time, but the pain and neurological dysfunction caused by tumors become the most important reasons that seriously affect patients’ quality of life and shorten their life expectancy accordingly. Patients urgently hope to relieve pain, preserve and restore nerve function, rebuild spinal stability and improve quality of life through treatment. With the rapid development of spinal surgical treatment technology in recent years, patients with metastatic spinal tumors, especially isolated solitary spinal metastases, are fully qualified for aggressive surgical manual treatment, which significantly reduces the tumor recurrence rate and significantly improves the survival rate of patients. The Tomita score proposed in 2001 is based on three factors: malignancy of the primary tumor, visceral metastases and bone metastases, each with a maximum score of 4 and a minimum score of 0. The higher the score, the worse the outcome. The scoring system not only determines which type of patients can be operated, but also allows direct decision on the surgical approach based on the scoring system. Patients with a score of 2-3 undergo extensive resection (meaning free outside the tumor pseudomembrane with a continuous layer of healthy tissue attached to the resected tumor) or marginal resection (meaning free whole resection along the tumor pseudomembrane or reactive tissue) for long-term local control; those with a score of 4-5 undergo marginal or intra-focal resection (operation performed within the tumor) for medium-term local control; those with a score of 6-7 undergo palliative surgery; and non-surgical supportive treatment only for scores 8-10. tomita [1] prospectively used the above scoring system and the corresponding treatment strategies in the development of treatment plans for 61 patients with spinal metastases with good results. It is now believed that surgery can be considered for patients with a life expectancy >6 months with one of the following conditions: tumors that are not sensitive to radiotherapy; spinal instability; compression of the spinal cord, cauda equina, or nerve roots by diseased vertebrae; acute or progressive neurological dysfunction; failure of radiotherapy, chemotherapy, or hormonal therapy; and unclear diagnosis requiring histopathological confirmation. Some scholars have suggested the use of prophylactic surgical interventions to stabilize the spine in cases of impending spinal instability. For such cases, Taneichi [2] proposed criteria for determining vertebral collapse: the thoracic segment (thoracic 1-10) is susceptible to vertebral collapse when 50-60% of the vertebrae are involved or 25-30% of the vertebrae are damaged combined with damage to the cribriform joints; the thoracolumbar and lumbar segments are susceptible to vertebral collapse when 35-40% of the vertebrae are involved or 20-25% of the vertebrae are involved combined with damage to the posterior structures. Because of the difficulty of spinal surgery and the complexity of the surrounding structures, most previous surgeries have used intratumoral scraping or piecemeal resection, with a local recurrence rate of more than 90%. Currently, more scholars propose to perform total en bloc spondylectomy (TES) for metastatic spinal tumors, which is an oncologically significant resection of the tumor by using the technique of total spondylectomy to achieve marginal or extensive resection. Tomita reported that in 28 patients with metastatic spinal tumors resected by TES, the average survival was 38.2 months and 93% of the patients had local control; in 13 patients resected by intrathecal resection, the average survival was 21.5 months. The mean survival was 10.1 months and local control was achieved in 72% of patients in 11 patients using palliative resection [1]. Kevin et al. analyzed the results of surgery for 80 isolated spinal metastatic tumors; the recurrence rate was 32% in 72 patients with intratumoral resection, 17% in 6 patients with complete resection, and 90 percent of patients had significant improvement in postoperative neurological function, 95 percent of patients had pain relief pain after surgery, 76 percent of patients had complete disappearance of pain symptoms after surgery, and the average survival of patients was 3 years [3]. This suggests us that TES can reduce local tumor recurrence and improve patients’ quality of life as long as appropriate cases are selected and surgical indications are strictly controlled. Tomita classified spinal metastases into three categories and seven types according to the mode of local invasion of spinal tumors and the anatomical site of involvement to select the indications for the modality eligible for TES resection. For tumors with intra-interstitial lesions (types 1 to 3), extensive resection or at least marginal resection should be performed. For tumors with extrainterstitial lesions (types 4 to 6), marginal resection is possible only if a fibrous reactive zone is present around the lesion. Whole spine resection is indicated for types 2 to 5, with types 1 and 6 being relative indications and type 7 being contraindicated. the WBB staging method proposed by Boriani et al. laid the theoretical foundation for the treatment of metastatic tumors of the spine. He divided the spine into 12 sectors in a clockwise direction on a cross-sectional view of the spine, and from the paravertebral to the spinal canal into 5 tissue levels from A to E. Among them, the anterior structures were zones 4 to 9, and the posterior structures were zones 1 to 3 and 10 to 12. According to WBB staging, for patients with tumor involvement in zones 4 to 8 (or 5 to 9), if the tumor has involved one side of the pedicle, total spine resection in the oncological sense can be achieved through osteotomy of the normal vertebral plate and the contralateral pedicle on the side not involved by the tumor; if both sides of the pedicle are involved by the tumor, that is, patients with WBB division in zones 4 to 9, total spine resection in the anatomical sense can only be achieved (when the tumor When the tumor invades bilateral arch root, the tumor will inevitably enter the arch root osteotomy and cause contamination of tumor cells, but the arch root is the narrowest part connecting the anterior and posterior sides of the vertebral body, so the osteotomy volume is minimal and the contamination of tumor cells can be reduced to the minimum. This resection method belongs to the category of intratumoral resection, which is a total spinal en bloc resection in the anatomical sense). In the past, en bloc resection of the whole spine was mainly performed through a combined anterior-posterior approach, which was a long, traumatic, high-risk, and bleeding procedure, limiting the application of this procedure in the treatment of metastatic tumors of the spine. In recent years, with the rapid development of spinal surgery technology, the technique of posterior en bloc resection of the thoracolumbar spine has been improved, and the operation time and bleeding volume have been significantly reduced. Nowadays, the operation time can be controlled between 6~10h and the bleeding volume can be controlled between 1000~1500ml. Our group of cases showed an average operative time of 7.7h, blood loss of 600 to 1800 ml, with an average of 1500 ml, and an average intraoperative transfusion of 1000 ml, similar to Tomita, with a significant improvement in VAS scores after surgery and a recovery of more than 1 grade of spinal cord neurological function Frankel classification, with no local recurrence of the tumor at the follow-up time of 2 years, and no patients until the last follow-up Tomita performed bilateral pedicle osteotomies and total spine resection after sawing the upper and lower discs of the diseased vertebrae with a specially designed wire saw. We modified the arch osteotomy technique by using a common wire saw to pass through the intervertebral foramen into the medial wall of the arch and cut off the arch, or by using a nerve stripper to protect the nerve and dura against the medial wall of the arch and a special curved bone cutter to cut off the arch. We also made our own foldable anterior great vessel baffle and used a homemade wire saw [5] or a two-step technique of surgical long knife to cut the intervertebral disc. No case of aggravated intraoperative nerve injury occurred during our total spine discectomy. The leap in thoracolumbar total spine resection technology has made surgical resection of spinal metastatic tumors possible, and patients can receive more aggressive, effective, and safe treatment. However, for cervical spine metastatic tumors, it is still impossible to achieve whole spine resection of the cervical spine. The tumors of thoracic spine and lumbar 1 can be completely resected in one stage through the posterior approach, and the author has resected the tumors of lumbar 2, lumbar 3 and lumbar 4 in one stage through the posterior approach respectively, and there is only one case of root cuff tear. However, in principle, tumors below lumbar 2 should be operated anteriorly and posteriorly to prevent nerve injury, and total resection of lumbar tumors in the posterior approach should be attempted only on the basis of excellent surgical skills. In cases where surgical indications are available but total spine resection is not possible, pain and neurological compression can be relieved by removing large pieces of the tumor and rebuilding the stability of the spine. Intratumoral scraping or fractional total spine resection (means total spine resection by fractional resection. Because the contamination of tumor cells to the surrounding tissues is easy when resecting in blocks, this resection method belongs to the category of intratumoral resection) although the tumor can also be removed, but because the instruments inevitably enter the tumor tissues repeatedly, even if all the tumor and its surrounding healthy tissues of more than 3-5 mm are removed, it will cause the contamination of tumor cells to the local surrounding tissues and blood, and the local recurrence rate increases after surgery, but as long as the strict However, as long as the surgical indications are strictly controlled, the survival quality of patients can be improved. In a group of 24 cases of metastatic tumors of the thoracolumbar spine with spinal nerve damage and spinal instability, anterior decompression, cement reconstruction and fixation were performed with the assistance of thoracoscopy. After surgery, 8 cases underwent surgery at the primary site, and some cases received regular chemotherapy for 6 months after surgery. The average operation time was 175 min, and the surgical bleeding volume ranged from 700 to 2100 ml, with an average of 1050 m l. The spinal nerve function improved significantly after surgery, and the relief rate of postoperative low back pain was 100%. The satisfaction rate of patients at 6 months postoperatively was 94% [6]. For metastatic tumor destruction of the vertebral body causing severe local pain or pathological compression fracture of the vertebral body, patients who are not in a position to undergo metastasectomy can undergo percutaneous transluminal vertebroplasty. This surgical procedure can also relieve patients’ pain. However, this type of surgery is controversial in the treatment of malignant tumors, and there is a risk of tumor spread. In summary, the choice of surgical approach for patients with metastatic tumors of the spine should be determined on a comprehensive basis and should be individualized. The type of primary tumor is determined, the patient’s condition and functional expectations are evaluated, and less invasive surgery, or non-surgical treatment, is favored for patients with shorter expected survival or the presence of more severe medical disease. Patients with isolated metastatic tumors with an expected survival of more than 6 months and who are physically strong can be treated with a whole-block resection, and a large block resection is sought. Multiple metastatic tumors are not indicated for surgical resection. The technique of total spine resection has been improved by many scholars, and now it can approach the standard of extensive tumor resection and marginal resection. However, total spine resection is still an extremely complicated and high-risk procedure, which requires careful control of the surgical indications and avoiding the expansion of the indications.