I. Vertebroplasty (PVP) and kyphoplasty (PKP) Percutaneous vertebroplasty eliminates pain caused by spinal instability by placing a puncture needle through the skin into the diseased vertebral body under imaging monitoring and regaining spinal stability by injecting bone cement to restore the strength of the vertebral body. Subsequent improvements in vertebroplasty have given rise to kyphoplasty. Kyphoplasty corrects the kyphosis by inserting a balloon into the diseased vertebral body, expanding the balloon while restoring the height of the vertebral body, and further injecting bone cement to restore the strength of the vertebral body. Vertebroplasty and kyphoplasty are now commonly used to manage the mechanical pain associated with spinal tumors. The primary indication for vertebroplasty and kyphoplasty in the treatment of spinal metastases from cancer is pain resulting from spinal instability. There are three main forms of pain symptoms in patients with spinal tumors: local pain caused by the tumor itself growing; radicular pain caused by the tumor compressing the nerve roots; and axial pain caused by spinal instability resulting from the destruction of the vertebral body by the tumor. Bone cement is most effective in relieving axial pain because of its immediate stabilizing effect on the vertebral body after solidification. In addition to the mechanical stabilizing effect of bone cement on bone destruction after setting, bone cement has also been reported to have an anti-tumor cytotoxic effect as well as a tumor-killing thermal effect. Although the cervical spine is less commonly accumulated in cancer spine metastases, PVP has rarely been used in the past due to its special anatomy. Huegli et al. performed C1,C4 vertebroplasty via a lateral approach under the supervision of a new multifunctional image-guided treatment device. These reports make cervical metastases an indication for PVP as well. The overall complication rate for PVP and PKP is less than 10%, with the most common complication being localized pain at the puncture site, mostly due to bleeding, and commonly associated with treatment of multiple segments or metastases rich in blood supply such as kidney or thyroid cancer. Other complications include fractures of posterior vertebral structures, cement toxicity and, rarely, arachnoid cyst formation. The complication of PVP and PKP procedures that has received the most attention is leakage of bone cement. Amoretti et al. also reported a case of bone marrow mud embolism in the aorta after vertebroplasty in a patient with lumbar metastases from breast cancer. Although the rate of bone cement leakage is above 41%, most reports show that these leaks are asymptomatic and do not require further management. PVP and PKP procedures are now generally considered to be a safe technique with a symptomatic complication rate of less than 3%. In recent years, some scholars have tried to introduce radiofrequency ablation technology (RFA) into the treatment of cancer spinal metastases and combine it with PVP and PKP to achieve better treatment results. The RFA technique has achieved remarkable efficacy in the treatment of solid tumors such as liver cancer and breast cancer. The application of traditional RF ablation technique in cancer spine metastasis is limited to some extent, on one hand, because the important nerve structures adjacent to the vertebral body have higher requirements on the distribution of RF energy, and on the other hand, because the necrotic absorption of tumor tissues caused by RF ablation will bring new spinal instability factors. Gazis et al. concluded that unipolar RF ablation cannot accurately control the current and cannot be performed around the fragile nervous system, whereas the use of bipolar RF ablation can effectively change this situation and avoid damage to the neural tissue adjacent to the tumor. treated vertebral metastases with radiofrequency ablation under real-time temperature monitoring and found that there was less potential for neurological impairment when the intradural temperature was not higher than 45 degrees Celsius. Recent studies have shown that radiofrequency ablation of vertebral metastases followed by PVP would benefit in both killing tumor cells and stabilizing the spine, resulting in better treatment outcomes. by finite element analysis, Tschirhart et al. found that injection of bone cement after radiofrequency ablation technique helped to better restore the mechanical stability of the vertebral body. a data set by Hoffmann et al. showed that radiofrequency ablation Masala et al. combined radiofrequency ablation with PVP for the treatment of patients with vertebral pathological fractures and found that the patients experienced rapid pain relief and could support their weight. III. Vascular embolization technique Vascular embolization technique is another commonly used minimally invasive treatment for spinal tumors, which can be performed either by arterial cannulation or by percutaneous puncture. The main indication for vascular embolization is embolization of tumors with abundant blood supply prior to open surgical procedures, thus reducing intraoperative bleeding. In addition, for patients with metastatic spinal cancer who cannot tolerate surgery, vascular embolization can be used as a palliative treatment for local control of the tumor and relief of painful symptoms. Vascular embolization is particularly suitable for tumors with abundant blood supply, such as kidney cancer and thyroid cancer. Polyvinyl alcohol is the most commonly used embolization material, and other materials include coils, alcohol, and gelatin sponges. Complete embolization is achieved in approximately 80% of patients treated with embolization. The main complication of the vascular embolization technique is neurological impairment. Embolization of cervical spine tumors may cause infarction of the cerebellum or brainstem, but is usually asymptomatic, and embolization of thoracic spine tumors may result in impairment of spinal cord function, leading to motor sensory deficits in the limbs. Koike et al. performed arterial cannulation chemotherapy and embolization in patients with metastatic carcinoma of the spine, and 75% of the tumor blood supply was blocked, and found a positive correlation between the degree of blood supply blockage and pain relief, thus concluding that vascular embolization is an effective palliative treatment. [Truumees et al. concluded that 60% of spinal metastases are rich in blood supply and that embolization by transarterial cannulation reduces the risk of intraoperative bleeding. IV. Internal spinal fixation with a small incision Some patients with metastatic spinal cancer have extensive tumor destruction of the vertebral body, producing severe spinal instability and possibly spinal cord compression, and internal spinal fixation with a small incision has unique therapeutic value when PVP does not provide adequate spinal stability. Commonly performed open surgeries for metastatic cancer of the vertebral body include tumor lesion removal and reconstruction via the anterior approach and total spine resection and reconstruction via the posterior approach. These procedures are highly invasive, have high bleeding and complication rates, and patients who undergo open surgery often require a prolonged postoperative recovery phase. With palliative posterior internal spinal fixation, the upper and lower segments of the diseased vertebral body are fixed with pedicle screws, thus providing rapid stabilization of the spine and relief of pain symptoms on the one hand, and avoiding the trauma caused by open surgery on the other hand, allowing patients to recover within a short time after surgery and to receive further radiotherapy and chemotherapy as soon as possible, thus providing the possibility of tumor control. In posterior surgery, decompression of the vertebral plate can be performed if necessary to avoid or delay damage to spinal cord function. For metastatic cancer in the thoracic spine, the traditional anterior open surgery has a greater impact on respiratory function. In recent years, some scholars have tried to perform anterior tumor removal and internal fixation with the assistance of thoracoscopy. Compared with open-heart surgery, the postoperative recovery time of patients is significantly shorter and the incidence of complications is lower. In the surgical treatment of patients with metastatic spinal cancer, the introduction of minimally invasive concept to minimize surgical trauma has obvious advantages compared with traditional open surgery. Especially for patients who need to receive comprehensive treatment such as radiotherapy and chemotherapy, minimally invasive internal fixation shortens the surgical cycle and gains time for subsequent treatment. For metastatic spinal cancer, radiotherapy, chemotherapy, open surgery and pharmacological analgesia remain the mainstay of treatment, while minimally invasive percutaneous treatment techniques provide more options for palliative care.