Therefore, the coupling of CX3CL1-directed cellular interactions and the ICAM-1/LFA-1-mediated feedback loop between circulating NSCLC cells and VBMECs constituted a vicious cycle to recruit more CTCs, eliciting higher vertebral microvascular endothelial permeability and increasing the aggressiveness of tumor cells, which facilitated spinal metastasis of circulating NSCLC cells. The gene discussed is ICAM1; the disease is neoplasm.