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To explore the value of modified intraoperative real-time 125I seed implantation planning for lumbar lymph nodes metastases. We collected 26 lymph nodes metastases patients, who received 125I seed implantation from January 2015 to December 2021. 13 patients procedure were guided by modified intraoperative real-time treatment plan, and the rest were guided by conventional treatment plan. To compare the differences of the dosimetric parameters between pre-plan and post-plan of the 2 groups, and the percentage difference of the dosimetric parameters between the 2 groups. Then evaluate the curative effect and side effects after 6-month. There were no significant differences in dosimetric parameters between pre-plan and post-plan in modified intraoperative real-time treatment plan group, and showed significant differences in V 150 between pre-plan and post-plan in conventional treatment plan group(z =-3.045, P <0.001), and the rest dosimetric parameters of conventional treatment plan group showed no significant differences beforeand after operation(P >0.05). The percentage difference of V 150 between the 2 groups showed statistically significant(z =2.103 , P =0.004), and the rest dosimetric parameters showed no significant differences(P >0.05).6 months after the brachytherapy, the effective rate of Modified intraoperative real-time treatment plan group was 77%(10/13), and 46%(6/13) in Conventional treatment plan group, and no peritonitis and hemorrhage were observed. The application of modified real-time planning improved accuracy of dosimetric, reduced the high dose rate area, and provide guarantee for 125I seed implantation planning for lumbar lymph nodes metastases. [ABSTRACT FROM AUTHOR]