Answering this question is complicated by the fact that the need for surgery for spinal bone metastases from breast cancer must be rigorously evaluated. There are currently two main scoring systems for the evaluation of spinal metastatic tumors for surgery or not. For breast cancer spine metastasis, if it is solitary and there is no metastasis in other organs, surgery is recommended because it can lead to better outcome. If the breast cancer has metastases to other organs, but if it is resectable, the organ metastases are metastatic and not fast growing, and the single spinal breast cancer metastases are mixed or predominantly osteogenic, surgical resection is recommended and the patient can still achieve a greater gain. If the breast cancer has multiple metastases, metastases to other important organs and is in very poor general condition or paraplegic, and the metastases are predominantly osteogenic, surgery is not recommended. Breast cancer, even with multiple metastases in the spine, is still a good option for surgery if there are no metastases to other organs and if growth is slow or mixed or osteogenic in predominance. In addition, spinal stability assessment is also an important parameter in whether to operate for breast cancer spinal metastases. Parameters of spinal tendency to instability include: metastatic lesion spine located at the thoracolumbar or cervicothoracic junction, osteolytic destruction, pain, altered spinal force lines, vertebral compression of 50% or more, and posterior lateral column involvement. Spinal instability is an important reference in deciding surgery. The current guidelines on breast cancer treatment are mainly developed by chemotherapy internists and breast cancer surgeon groups, while orthopedic surgeons are lacking in the evaluation. Some internists do not advocate surgery for breast cancer spinal metastases, and less emphasis is placed on doing a comprehensive bone scan during the postoperative follow-up period of patients, which tends to miss the diagnosis of breast cancer bone metastases. Due to the development of comprehensive treatment of breast cancer, its survival rate and survival time have been greatly improved than before. Therefore, breast cancer with spinal metastasis needs to be treated aggressively, as aggressive treatment can lead to longer survival time and quality of life. It is difficult for patients to assess the above specialty scores on their own, and an experienced bone oncologist is needed to do so.