Surgical management for spinal metastasis is controversial. No clear consensus exists on deciding which patients should undergo surgery and what type of surgery is most appropriate. The primary goals of surgery are controlling the burden of local disease, preventing or slowing neurologic deterioration, and spinal stabilization when necessary. With the advent of more aggressive surgical procedures for spinal metastasis, the spine surgeon’s armamentarium has changed. Preexisting scoring systems fail to account for these newer surgical procedures, and most do not guide appropriate treatment. As such, the authors proposed to develop a novel, comprehensive, prognosis-based scoring system to guide specific treatment in patients with metastatic spine disease.