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 spine is a common site for bone metastatic cancer, accounting for about 40% of metastatic cancer patients. The most common sites for spinal 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 metastatic cancers of the spine 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 spine cancer 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 spinal cancer 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.Motor 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 spine. 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 spinal cord by tumor cells. The treatment for patients with metastatic cancer of the spine mainly focuses on 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 spinal metastases and the application of diphosphonates. However, 1-2% of patients still need surgical intervention. The objectives of surgical treatment for metastatic spinal cancer are: 1) decompression of the spinal cord or nerve roots to provide pain relief and restore the integrity of the spinal cord; 2) restoration of biomechanical stability of the spine; 3) clear diagnosis. For spinal lesions that are difficult to be diagnosed by other clinical means, the lesions can be incised and biopsied or removed through the surgical route. 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 spinal cancer include: 1. Simple spinal decompression: The commonly used method is spinal decompression. This method was the commonly used treatment before the 1980s. However, since the most common sites of spinal metastatic cancer are the vertebral body and the vertebral arch. The removal of spinal accessories destroys the stability of the spine, 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 tumor resection and reconstruction: With the recognition of Danis’ theory of the three-column structure of the spine, the current treatment for metastatic cancer of the spine is spinal lesion scraping or total spine resection, in order 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 body. The procedure often requires a posterior pedicle screw system in the spine or an anterior nail bar system to increase the spinal firmness of the adjacent segment. Biomechanical stability of the spine is restored immediately after surgery, pain relief is clear, and patients can be out of bed and performing normal activities of daily living 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, with good long-term results. However, the surgery is very traumatic, the cost of surgery is high, coupled with the short survival time of patients, it is often difficult to be accepted by patients and their families, and even clinical staff. 3, filling surgery of the spine: the more commonly used method is percutaneous or intraoperative vertebral body puncture cementoplasty or balloon expansion and shaping. The principle of this procedure is to use hard and plastic medical bone cement to fill the medullary cavity of the vertebral body 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 spinal cord compression and serious complications such as paralysis or even death. Therefore, there are strict indications for 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 that it is connected to large blood vessels before cement infusion. 4, other minimally invasive treatment of the diseased spine: the more commonly used methods are vertebral body puncture, heat therapy, chemotherapy, radiotherapy, etc. 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 alone. The main 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. With the diversification and simplification of treatment, more and more patients with metastatic spinal cancer are gradually receiving aggressive surgical interventions. Pain-free and normalized life is gradually becoming the survival goal for patients with metastatic spine cancer.