Abstract Objective To retrospectively analyze the clinical effect of microwave ablation combined with vertebroplasty and pedicle screw fixation in the treatment of spinal metastases.Methods: From January 2019 to June 2020, 15 patients with thoracolumbar metastases treated by microwave ablation combined with vertebroplasty and pedicle internal fixation were selected as the research objects (microwave group), and 22 patients were treated by vertebroplasty alone at the same time (control group). The operation time, intraoperative blood loss, hospitalization time, bone cement leakage and postoperative complications （infection nerve injury）, All patients were followed up for preoperative, 1 week and 6 months pain score, American Eastern cancer collaboration group score(ECOG), Cobb angle and 6 months survival rate.Results (1) the operation time, intraoperative blood loss, hospitalization time and complications of the observation group were significantly higher than those of the control group (P < 0.001). There were 4 cases of perioperative complications (26.67%) in the observation group, including 2 cases of poor wound healing, 1 case of pulmonary infection and 1 case of deep vein thrombosis, which were significantly higher than those in the control group. ② There were 3 cases of nail leakage and 1 case of vertebral leakage in the control group, which were significantly higher than those in the observation group (x2 = 3.942, P = 0.047). The average amount of bone cement injection in the observation group was 4.52±1.07ml, which was significantly higher than that of the control group 3. 68±0.95ml, the difference was statistically significant (t = 2.509, P=0.017). ③ The VAS scores of the two groups at 1 week and 6 months after operation were significantly better than those before operation (P < 0.001). Six months after operation, ECOG score, VAS score and Cob angle of the observation group were better than those of the control group (P < 0.05).Conclusion Microwave ablation combined with vertebroplasty and pedicle screw fixation in the treatment of spinal metastases is superior to vertebroplasty alone in safety and medium-term efficacy.