With the aging population and the improvement in the diagnosis and treatment of cancer, the incidence of spine metastasis is increasing. The treatment paradigm for spinal metastases involves a multidisciplinary cooperative medicine. Orthopedics doctor is one member of the team. Their role is important and cannot be replaced. Surgery can relive refractory pain, maintain or regain ambulatory status, and improve patients′ quality at last. Therefore, patients can receive the following systematic treatment of tumor in a better status. The clinical manifestations, stability of spine, number and locations of spine metastasis, sensitivities of radiation and chemotherapy, expected survival prognosis, and radiology need to be considered in the decision-making to maximize the efficacy and minimize the risk of surgery. Although en bloc and total en bloc spondylectomy can achieve favorable survival outcome, those methods have narrow surgical indication, high risk and complication rate. Thus, those methods are still under debate. Minimally invasive surgery is the trend of surgery, many minimally invasive surgeries are booming. This review discusses the advancement and principles of surgery in patients with spine metastasis.