We experienced a case of 44-year-old male patient complained of back pain, and the symptom was due to metastatic lung cancer. Back pain is one of the most commonly treated conditions by all physician office visits. However, when back pain does not improve with conservative treatment, further evaluation is indicated. Squamous cell carcinoma and adenocarcinoma are the lung cancers that mostly metastasis to vertebrae. Most of the metastases involve multiple spinal levels, and bone metastases are a significant and undertreated clinical problem in patients with advanced lung cancer. There is a tendency to overlook serious pathology as a cause of back pain when the patient is relatively young or lacks systemic signs and symptoms.