- Thoracolumbar injuries can cause neurological injury and long-term pain. They require assessment of fracture classification and the integrity of the posterior ligamentous complex to determine appropriate management as surgical or nonsurgical. - Surgical approaches include posterior, anterior, or combined based on the fracture type and neurological status. Proper classification guides treatment to decompress the spine and restore stability. - Complications include problems from immobilization as well as implant failure and infection. Careful consideration of fracture morphology, neurological findings, and ligamentous integrity directs optimal treatment.