In recent years, with the increase of tumor incidence, many patients have skeletal metastasis, especially spinal metastasis, causing local pain or even paralysis, which seriously affects the quality of life of patients, I found in my clinical work that many patients and their families and even many doctors think that once spinal metastasis occurs, the tumor has reached an advanced stage and there is no value for surgery and give up treatment, even some patients survive for a long time after metastasis. Some patients even survive for a long time after metastasis, which causes great pain during the survival period of patients. So when do spinal metastases require surgery? In general, whether or not to use surgical intervention for spinal metastases depends on several factors, including whether the primary tumor is removed, whether the spine has a single metastasis or multiple metastases, the malignancy of the primary tumor, whether there are metastases to important organs, the estimated survival time of the patient, and the economic conditions. If the malignancy of the primary tumor is low, such as thyroid cancer, breast cancer, kidney tumor, etc., the estimated survival period is more than 6 months; if the single metastasis is insensitive to radiotherapy, it is estimated that the spinal cord will be compressed in the short term with symptoms of paralysis; if there is no important organ metastasis; if there is no local recurrence of the primary focus and resection, and there is a single metastasis in the spine; although there is multiple metastasis, it is likely that a certain local area will have spinal cord compression in the short term. Tumors that are compressed and sensitive to other medical treatments; patients with certain economic and physical conditions that can tolerate surgery. In our clinical work, many patients treated based on the above principles have significantly improved their quality of life during the survival period, and even indirectly prolonged their survival period due to the reduction of related complications after surgery as the patient’s physical and psychological condition improves. Therefore, it is recommended that patients with spinal metastases actively consult with the relevant medical professionals and make a rational choice of surgical or non-surgical treatment options based on a comprehensive evaluation of their condition.