Objectives: To assess the clinical value of 99mTc-MDP SPECT, low-dose CT and fusion imaging used in differentiating malignancy from benignancy in spinal diseases and the value of low-dose CT for diagnosis. Methods: Using GE-Millennium VG with Hawkeye, 99mTc-MDP SPECT/CT was performed in 49 patients with abnormal uptake only in spine(lesion number≤3) by 99mTc-MDP scanning, which produced 99mTc-MDP SPECT, low-dose CT and fusion imaging. All patients were diagnosed by MRI or high-resolution CT within a month, pathology or follow-up more than one year. Results: The diagnostic sensitivity of 99mTc-MDP SPECT, low-dose CT and fusion imaging for 49 patients was 81.4%, 86.0% and 100%, respectively. The specificity of three types of imaging was 72.5%, 98.0% and 96.1%, respectively. It proved that 99mTc-MDP SPECT/CT could not only provide the precise anatomic definition of lesions, but significantly improve the diagnostic sensitivity and specificity. In addition, to decrease the false positive cases, should analyze the small lesion sites with caution, although low-dose CT was satisfying in diagnosis; when low-dose CT did not accord to 99mTc-MDP SPECT, should compare them through and through. Conclusion: Fusion imaging of 99mTc-MDP SPECT and low-dose CT provided a significant clinical value for vertebral metastatic tumor and it should be used as a supplementary examination to the 99mTc-MDP scintigraphy.