Spinal tumors often have insidious onset, varying symptoms and lack of specificity. The treatment of spinal tumors depends first of all on accurate diagnosis (nature, localization, distribution, presence of concomitant diseases, etc.), so a comprehensive and detailed diagnosis is essential for the treatment of spinal tumors. Young spine surgeons tend to emphasize complex surgical techniques and neglect the more critical preoperative diagnosis, and also tend to underestimate the role of comprehensive treatment in the management of spinal tumors. Common examination methods such as CT, MRI, bone scan, etc. are not discussed here. The progress of spinal tumor examination methods comes first from the rapid development of imaging examination. The most advanced examination method is PET-CT (Positron emission tomography – computed tomography), which combines whole-body tumor imaging with CT and is capable of early detection of primary lesions and metastases, especially for the diagnosis of metastatic cancer. In developed countries, PET-CT has become one of the standard examinations for the evaluation of spinal tumors (especially spinal metastases). Some scholars also believe that whole-body MRI is better. The two have complementary features and their common disadvantage is their high price. Currently, the diagnosis of spinal tumors still requires a triad of clinical, imaging, and pathological findings. Imaging mainly provides the localization and distribution of the tumor, clarifies the relationship between the tumor and the surrounding anatomy, and provides a preliminary analysis of the nature of the tumor. Only very few spinal tumors have a characteristic presentation (e.g., osteoid osteoma); it is often difficult to accurately estimate the pathologic nature of most tumors based on imaging alone. For example, chordoma can be clinically misdiagnosed as neurofibroma, tuberculosis, hemangioma, etc. Some physicians rush without preoperative pathologic biopsy, only to discover postoperatively that it is a chordoma. Even spine oncologists are inevitably misdiagnosed. Misdiagnosis and misdiagnosis due to clinical experience alone will bring incalculable damage to the patient’s.