Between 1985 and 1992, 84 burst fractures were surgically managed with anterior decompression, autologous iliac crest strut graft, and posterior instrumentation and fusion. Fifteen were lost to follow-up, leaving 69 patients for detailed review. Of the 22 patients with complete or partial neurologic injury, 12 patients either totally or partially recovered function following surgery. Of these 12 patients, 6 improved 1 Frankel grade; 5 improved 2 Frankel grades, and 1 improved 3 Frankel grades. Follow-up was 12 to 91 months (average 41 months). For all of the fractures in this series, the mean operative correction in sagittal kyphosis was 14 degrees, but this decreased to 7 degrees at final review. No patient had significant scoliosis, and 66 patients achieved solid arthrodesis with 3 pseudoarthroses (4%). Mean operative time for 2-in-1 procedures was 5 hours 42 minutes, with an estimated blood loss of 1,455 mL. Of 62 patients available for follow-up telephone interview, 42 (68%) had minimal or no pain; 11, mild pain; 8, moderate pain; and 1, severe pain. Function in daily activities was assessed as normal or minimally impaired in 43 of 51 patients (84%) with normal neurologic function by physical examination. We conclude that anterior decompression, strut autografting, and posterior instrumented autogenous fusion, either as a combined or staged procedure, is a safe surgical option for thoracolumbar burst fractures.