Tumor has become the top three causes of death in China. According to the statistics in 2005, there are 2.2 million new tumor patients in China every year, and as many as 1.6 million patients died due to tumor. With the improvement of tumor primary site treatment and radiotherapy level, the survival time of tumor patients has also been significantly extended. In this way, the occurrence of bone metastasis has also increased accordingly. According to statistics, 30%-90% of tumor patients can have bone metastasis, and the spine is the most likely site of metastasis in the skeletal system. The cases of bone metastasis can be roughly divided into two categories. The first situation is that patients who had a history of tumor before, but this time, spinal metastasis is found due to pain or numbness and weakness of limbs. The second situation is that the patient has never had a history of tumor before, but this time, bone metastasis is suspected due to pain or numbness and weakness of the limbs and bone destruction is found in the spine. The following is the diagnosis and treatment process for patients with metastatic cancer in the spine according to these two cases respectively. Patients with previous history of tumor should first undergo formal treatment, including radiotherapy, chemotherapy or surgery, according to the nature and location of the primary tumor. Tumor is a lifelong disease, and after the first treatment, it is important to seek regular review from professional doctors. If there is persistent pain in the neck and back or low back, especially pain at night or pain at rest, you must be alert and go to the hospital for clinical examination by an orthopedic surgeon and, if necessary, a whole-body bone scan first. A whole-body bone scan is a very sensitive screening test for bone metastases. Don’t trust the X-ray plain film, because only when the bone destruction causes more than 50% reduction of bone volume can be shown on the X-ray plain film. Screening tests for bone metastases are, in descending order of sensitivity, bone scan, MRI, CT and X-ray plain film. If a bone scan reveals a suspicious lesion, further examinations, including MRI and CT, will be performed depending on the location of the lesion. Patients in the second case are often found to have bone destruction in the spine or even the presence of pathological fracture and/or nerve compression after examination in the hospital because of pain or numbness and weakness in the extremities. At this point, it is necessary to determine whether the tumor is a primary bone tumor or a metastatic cancer, as this has a very close relationship to treatment and prognosis. If the patient is not at risk of severe spinal cord compression and paralysis, we generally recommend that the patient first undergoes CT-guided puncture biopsy to make a definitive pathological diagnosis by sectioning. However, it takes some time to obtain a pathological diagnosis, usually around 7 to 14 days. Therefore, if the patient has progressively worsening spinal cord compression, this is not a good way to confirm the diagnosis. At this point, we can do PET/CT, which is by far the most sensitive tumor screening tool, and can detect tumors not only in the bones but also in the soft tissues of the whole body. Therefore, it is possible to find out not only how many bones in the skeletal system are involved, but also the primary site of the tumor (e.g. lung, liver, breast, prostate, intestinal canal, etc.). The PET/CT results are obtained quickly (usually in about 2 days) and can be used to determine where the tumor is coming from and how many other metastases are present throughout the body. This is of great importance for the overall treatment planning. However, the disadvantage of this test is that it is expensive, ranging from about 9,000 to 14,000 RMB, and it is largely self-pay. Once we have clarified the diagnosis of metastatic spinal cancer through a series of tests, we need to start developing the appropriate treatment strategy. This is a process that requires the collaboration of multiple departments, requiring the joint efforts of the primary tumor department, orthopedics, oncology chemotherapy, oncology radiotherapy, pathology and imaging disciplines. Generally, we need to make a comprehensive assessment based on the patient’s general condition (patients with metastatic cancer are often frail), the nature of the primary tumor, the metastasis of important organs (liver, lung, brain, etc.), the number of vertebral metastases, the number of extra-spinal bone metastases, and the presence of paralysis, to predict the patient’s survival time, and then determine what kind of treatment is appropriate for the patient and the order of treatment. Orthopedic treatment is an important part of the treatment of metastatic spinal cancer, but it is by no means the only part. In the vast majority of cases, what we need to do is stabilize the spine that has been or is about to be fractured and partially remove the tumor to relieve spinal cord or nerve compression with the goal of improving the patient’s quality of life and allowing the patient to undergo treatment such as chemotherapy, radiation or treatment of the primary tumor. In a few cases, we can also cure the metastatic cancer patient by complete tumor resection. Given the complexity of metastatic cancer of the spine, we hope that the patient will visit the hospital and we will make a specific analysis of the problem so that we can develop the most reasonable treatment plan for the patient.