Background: High quality studies have been challenging to undertake in patients with metastatic epidural spinal cord compression. Nonetheless, in the article“Survival and Clinical Outcomes in Surgically Treated Patients With Meta-static Epidural Spinal Cord Compression: Results of the Prospective Multicenter AOSpine Study”recently published in the Journal of Clinical Oncology, our team provided convincing evidence that spinal surgery improves overall quality of life in patients with this potentially devastating complication of cancer. Considering that metastatic spinal lesions treated with surgery have the highest mean cost among all oncological musculo-skeletal issues, it is essential to pro-vide high quality data to optimize the therapeutic approaches and cost-effective use of health care resources. Main body: Although the AOSpine Study provided high quality prospective data, it was primarily limited by the lack of non-operative controls and the relatively small sample size. Given the dearth of medical equipoise and the funda-mental difference between patients deemed to be adequate surgical candidates and those who are not amenable to operative intervention, conducting a randomized controlled trial in this patient population was not felt to be ethi-cally or medically feasible. Consequently, the optimal option to overcome limitations of both the lack of controls and the relatively small sample size is through collection of large prospective datasets through rigorously developed and maintained registries. Conclusions: With the alarming increase in the incidence of cancer in China and China’s parallel growing cancer con-trol efforts, China would offer a fantastic platform to set up a national metastatic spinal lesion registry. Such registry would not only enhance metastatic epidural spinal cord compression translational research but also optimize patient care.