Study Design <p>A case report.</p> Objective <p>Presentation of transpedicular approach for endoscopic spine surgery (ESS) in a patient with thoracic spine metastases from lung cancer with incomplete paralysis.</p> Background <p>The spine is the most colonized site for tumor bone metastases, and approximately 5–10% of patients develop symptoms of nerve and spinal cord compression. Traditional open surgery is the best management strategy to address patients’ neurological symptoms, but its demanding physical status and low clinical benefit in end-stage patients limit its application in spinal metastases. With the accumulation of experience and technological breakthroughs in ESS, this technology has become an ideal choice for palliative treatment of patients with end-stage spinal metastases.</p> Method <p>A patient with thoracic spine metastasis from lung cancer with incomplete paralysis was treated with ESS using a transpedicular approach.</p> Results <p>A patient with lung cancer thoracic spine metastasis with incomplete paralysis was unable to tolerate traditional open surgery due to her physical condition, so our team used the strategy of spinal endoscopic decompression with tumor resection via transpedicular approach to treat him. After the operation, the patient’s pain and neurological symptoms were significantly relieved, and he regained the ability to walk on himself within two months. Moreover, the technique prolonged his survival while safeguarding his quality of life.</p> Conclusion <p>ESS is ideal for patients with end-stage spinal metastases.</p>