Tumor patients have the highest incidence and mortality rate by far, and about 50-70% of malignant tumor (cancer) patients will have bone metastasis, and the crest is a common site for bone metastatic cancer, accounting for about 40% of metastatic cancer patients. The most common sites of crestal tumors are: 85% of the vertebral body, 10%-15% of the adnexa, and 5% of the internal and external spinal canal. The most frequently occurring crural metastatic cancers are: breast cancer, lung cancer and prostate cancer. They are followed by kidney cancer, gastrointestinal tumors, thyroid cancer, lymphoma and myeloma. The incidence of metastatic cancer in the crest continues to increase with the development of available detection methods, the increase of anti-cancer tools, and the increase of patient survival. About 10% of patients with metastatic cancer of the crest will have clinical symptoms, mainly manifested as low back pain, which are divided into the following three types: 1. Resting pain. Patients show persistent low back pain, which is often more obvious at night. This is more obvious in the advanced stage of tumor. It is mainly caused by the swelling growth of tumor cells, which compress the surrounding periosteum, nerve endings in the bone marrow cavity and sinus vertebral nerve. 2.Motion pain. Patients show severe pain in low back when they change position, such as turning over, sitting up, lying down and other activities. It is mainly caused by the destruction of vertebral trabeculae and bone cortex by tumor cells, resulting in pathological fracture of vertebral body and causing the destruction of biomechanical stability of the crista. 3.Neuralgia. Patients show unbearable and persistent pain, which often radiates to the chest, abdomen or lower limbs. In severe cases, serious complications such as paralysis occur. It is mainly caused by the compression and stimulation of nerve roots and crestal medulla by tumor cells. The treatment for patients with crestal metastasis cancer is mainly pain relief and prevention of paralysis. According to the causes of pain and the limited survival time of patients, the treatment is mainly through a combination of conservative means such as chemotherapy for the primary disease, radiotherapy for the crural metastases and the application of diphosphonates. However, 1-2% of patients still need surgical intervention. The objectives of surgical treatment for metastatic carcinoma of the crest are: 1) decompression of the crestal medulla or nerve roots to provide pain relief and restore the integrity of the crestal medulla; 2) restoration of the biomechanical stability of the crest; 3) clear diagnosis. For crural lesions that are difficult to be diagnosed by other clinical means, the lesions can be incised and biopsied or removed by surgical means. And the ultimate goal of surgery is to improve the quality of survival within the limited survival time of the patient. The current surgical treatments for metastatic cancer of the crest include: 1. Simple crestal decompression. The commonly used method is crestal decompression. This method was a commonly used treatment before the 1980s. However, since the most frequent sites of crestal metastatic cancer are the vertebral body and the pedicle. The removal of the crestal attachments destroys the stability of the crestal column, resulting in poorer surgical results and even inferior to the efficacy of conservative treatment, which once caused the situation of “fear of surgery”. 2.Vertebral body tumor resection and reconstruction surgery. With the recognition of Danis’ theory of the three-column structure of the crest, the current treatment for metastatic cancer in the crest is scraping or total crestal laminectomy to partially or completely remove the lesion. The surgery is accompanied by reconstruction of the postoperative vertebral defect using a titanium mesh or artificial vertebral body that is more compatible with the human body. The procedure often requires a posterior pedicle screw system in the crest or an anterior nail bar system to increase the crestal firmness of the adjacent segment. The biomechanical stability of the crest is restored immediately after surgery, pain relief is clear, and patients can be out of bed and performing normal daily activities within a short time after surgery. Complications such as loosening or breaking of the prosthesis and internal fixation are less likely to occur during the patient’s survival period, and the long-term results are good. However, the surgery is very traumatic and costly, plus the short survival time of patients, which is often difficult to be accepted by patients and their families, and even clinical staff. 3.Filling surgery of the crest. At present, the more commonly used method is percutaneous or intraoperative vertebral body puncture bone cement forming or balloon expansion forming. The principle of this operation is to use hard and plastic medical bone cement to fill the vertebral medullary cavity destroyed by the tumor, so as to restore the stiffness of the vertebral body itself; in addition, the bone cement has the purpose of partially killing the tumor cells, thus playing the role of local “chemotherapy”. This method is easy to perform, with little damage to the patient, low cost, and can even be done on an outpatient basis, and the surgical effect is immediate, so it is very easy to be accepted by the patient and his family. However, the most serious complication of this procedure is the leakage of bone cement, especially into the spinal canal and blood vessels, which can lead to compression of the crestal medulla and, in severe cases, to paralysis or even death. Therefore, there are strict indications for the surgery, especially the posterior wall of the diseased vertebral body should be intact, and it should be clear that there is no vascular breakage around the puncture site and connected with large blood vessels before the bone cement infusion. 4, other minimally invasive treatment of the diseased crest. At present, the more commonly used methods are vertebral body puncture, heat therapy, chemotherapy and radiotherapy at the lesion site. Such as radiofrequency ablation of the lesion, argon helium knife treatment, radioactive ion implantation, adriamycin liposome implantation, etc. These methods are often difficult to be widely carried out due to the limitation of corresponding equipment. Moreover, the tumor growth habits are different and the effects are not the same. At present, more and more clinical studies show that the effect of surgery combined with adjuvant radiotherapy is significantly better than that of radiotherapy treatment alone. The advantages are: patients’ bed rest time is significantly shortened, pain is significantly reduced, the rate of paralysis is significantly reduced, and their ability and confidence in daily life are significantly improved. Moreover, with the diversification and simplification of treatment, more and more patients with metastatic cancer of the crest are gradually receiving aggressive surgical interventions. Pain-free and normalized life is gradually becoming the survival goal for patients with metastatic cancer of the crest.