Spine surgery involves various types of diseases, with a wide range of theoretical knowledge, and it is difficult to teach. The traditional teaching method has many problems, such as the content is difficult to understand and memorize, the theoretical knowledge of the textbook is out of touch with the clinical knowledge, and the lecture process is monotonous and boring. During the COVID-19 epidemic, the case-based teaching method was applied to the small-class teaching of spine surgery and achieved good teaching results. It not only promoted collaboration between students, but also cultivated students' critical thinking and deepened their understanding of knowledge, and improved learning efficient. There is few report to summarize the specific mode of case teaching method in spine surgery teaching. This article combines the author's experience in clinical teaching, discusses and summarizes three different case teaching methods, and analyzes the challenges they face in the application process.