Objective：To develop a scoring system for rapid outpatient differential diagnosis of SM and STB and to improve outpatient diagnostic accuracy. Methods：The records of 141 patients who had a pathological diagnosis of SM or STB from 2014 to 2016 in our department were retrospectively reviewed. The following clinical and imaging data that they provided in outpatient were recorded：age，gender，relative history，number of the vertebral lesions，the distribution of vertebral lesions，the involved vertebral element，the intervertebral disc was involved or not，if there was a sequestra formation and if there was a soft tissue component. Then a multivariate logistic regression analysis was conducted，and the rapid outpatient differential diagnosis scoring system was established. Results：Among the total 141 patients，82 cases were diagnosed with SM and 59 cases were STB. Multivariate logistic regression analysis showed that age，gender，relative history and a soft tissue component can hardly provide accurate diagnostic information. The rapid outpatient differential diagnosis scoring system was based on four characteristic imaging features namely the distribution of vertebral lesions，the involved vertebral element，the intervertebral disc was involved or not，and if there was a sequestra formation. SM showed a statistic significant higher score than did STB（6.09 vs. 1.56，t=-18.157，P=0.000）. The sensitivity and specificity of rapid outpatient differential diagnosis scoring system were 86.44% and 96.34%，respectively. Conclusion：The differential diagnosis scoring system shows satisfactory sensitivity and specificity in rapid outpatient diagnosis of SM and STB. Spinal lesions with the score of 0 to 3 are STB，and the score of 4 to 7 are SM. This scoring system still needs further revision and improvement.