Purpose: The criteria for identifying lung cancer patients with metastatic spinal cord compression (MSCC) who may benefit from decompressive surgery remains unclear. This study aims to create a new therapeutic strategy which can guild surgeons to select the individual treatment for MSCC patients from lung cancer. Methods: We retrospectively assessed 73 consecutive lung cancer patients who were treated with decompressive surgery for MSCC. Twelve preoperative characteristics were analyzed for postoperative survival. Characteristics significantly associated with survival in the multivariate analyses were included in a scoring system. The total score for each patient was obtained by adding the scoring points of all significant characteristics. Postoperative function outcome was also analyzed according to prognostic groups. Results: In the multivariate analyses, preoperative ambulatory status (P = 0.02), targeted therapy (P = 0.01), number of involved vertebrae (P < 0.01), visceral metastases (P < 0.01), and time developing motor deficits (P < 0.01) had significant impact on survival and were included in the scoring system. According to the prognostic scores, which ranged from 15 to 35 points, three prognostic groups were designed: 15-23 points (n = 32), 25-29 points (n = 26), and 31-35 points (n = 15). The corresponding median survival times were 2.6 months (95% CI, 1.5-4.3 months), 7.2 months (95% CI, 6.0-10.8 months) and 13.2 months (95% CI, 8.8-18.7 months), respectively (P < 0.01), and the corresponding postoperative ambulatory rates were 46.9%, 80.8%, and 93.3%, respectively (P < 0.01). Conclusion: We present a scoring system for lung cancer patients with MSCC after surgery based on survival and functional outcome. The scoring system can guild surgeons to select the individual strategy for patients with MSCC from lung cancer. (C) 2016 The Authors. Published by Elsevier Ltd.