The lack of robust clinical studies has contributed to controversy regarding optimal treatment for patients with injuries to the thoracolumbar spine. The transitional anatomy of the thoracolumbar spine makes it vulnerable to injury resulting from high-energy motor vehicle collisions and falls; osteoporosis is an underlying factor in most of the compression fractures identified in elderly patients. The formulation of a treatment plan for patients with injuries to the thoracolumbar spine depends on the presence and extent of neurologic injury and deformity and an estimate concerning spinal stability. Both nonsurgical and surgical treatment options are available to achieve the goals of preservation of neurologic function and restoration of spinal stability.