Abstract: The spine is a common site for bone metastasis in lung cancer, which often leads to severe complications such as pathological fractures and neurological dysfunction in patients, with a generally poor prognosis. The particularity of the spine and the tumor microenvironment (TME) together constitute a favorable ecological niche. During the metastatic process, the TME plays a core regulatory role. The complex components of the TME, along with the rich vasculature and signaling molecules in the spine, work together through complex interactions to promote the invasion and colonization of tumors in the spine. In recent years, with the continuous exploration of the impact of TME on spinal metastasis of lung cancer, researchers have proposed a variety of emerging treatment strategies based on TME, such as nanotherapy, sonodynamic therapy, gene therapy, and combination therapy. These strategies have shown significant potential for clinical translation and have provided new ideas and methods for the subsequent precision treatment of spinal metastasis of lung cancer.