Metastatic spinal tumors are the most common malignant tumors of the spine. The choice of treatment and prognosis depend on factors such as the type of primary cancer, Karnofsky score, neurological status (paraplegia, ambulation, etc.), number of lesions, presence of distant metastasis, and presence or absence of spinal cord compression. Treatment goals for metastatic spine tumors remain palliative and aim to alleviate symptoms and improve quality of life, in addition to the traditional goals of local tumor control. Treatment options for this condition include radiotherapy, radiotherapy combined with systemic chemotherapy, hormone therapy, vertebroplasty/kyphoplasty, surgical decompression combined with radiotherapy, and extracranial radiosurgery. It is important to consider the benefits and risks of each option before making a decision. The scoring systems, such as Tomita, NOMS, and Revised Tokuhashi, are employed to determine the most appropriate course of treatment. Surgical intervention is indicated in cases of persistent pain, spinal cord compression, and pathological fractures that require stabilization. The surgical procedure entails decompression and, in instances where it is deemed necessary, additional stabilization.