〔Abstract〕 Objective To investigate the relationship between the slope of spectral computed tomography (CT) curve, CT value and angiogenesis and prognosis in patients with spinal bone metastases. Methods A total of 78 patients with spinal bone metastases admitted to the General Hospital of Pingmei Shenma Group from July 2021 to March 2022 were selected. According to the microvessel density (MVD) of tumor tissue, they were divided into high density group (32 cases) and low density group (46 cases). The slope and CT value of the spectral CT curve were compared between the two groups, and the correlation between the slope and CT value of the spectral CT curve and MVD was analyzed. After 6 months of follow-up, the slope of spectral CT curve and CT value of patients with different prognosis were compared at admission, 1 month and 3 months after admission, and their predictive value for the prognosis of spinal bone metastases was analyzed. Results Compared with the low-density group, the slope and CT value of the spectral CT curve in the high-density group were higher. Compared with the survival patients, the death patients had higher slope and CT value of spectral CT curve at admission and 1 month after admission; the differences were all statistically significant (P < 0.05). The correlation analysis showed that MVD was positively correlated with the slope of spectral CT curve (r = 0.725, P < 0.001) and CT value (r = 0.763, P < 0.001). Receiver operating characteristic curve (ROC) analysis showed that, the area under the curve (AUC) of the slope of spectral CT curve and CT value in predicting the death of patients with spinal bone metastases was 0.784 and 0.760, respectively, the AUC of combined prediction was 0.927, higher than single index prediction; The results of risk analysis showed that the mortality risk of patients with high levels of curve slope and CT value was 3.833 and 4.778 times that of patients with low levels, respectively (P < 0.05). Conclusion The slope of spectral CT curve and CT value can be used to evaluate the angiogenesis of spinal bone metastases. It provides a reference for clinical early prediction of prognosis, so as to carry out followup treatment and improve prognosis.