The primary focus is lung cancer, and the thoracic spine is the most common site of metastasis. In this case, the treatment of the primary lung lesion will be based on chemotherapy, and the specific chemotherapy regimen or treatment method can be consulted with the thoracic surgeon. For the treatment of bone metastases, mainly based on the symptoms, the degree of local destruction of the vertebral body can be determined by local CT. If the destruction of the vertebral body is not serious and there is no symptom of pain aggravated by sitting up or standing, radiotherapy for vertebral metastases can be considered. However, this can only achieve the relief of pain symptoms. If the destruction of the vertebral body is serious and there are signs of structural instability (pain is aggravated when sitting up or moving, pain is relieved when lying down), it is recommended to consider surgical treatment. The best treatment modality is determined based on the patient’s systemic condition, treatment of the primary lung lesion, and the degree of vertebral destruction. Regardless of the treatment modality, regular use of diphosphonates is recommended whenever malignant bone metastases are present.