♦ High-energy trauma often results in serious spinal fractures. The junctional zone between the relatively stiff thoracic spine and the more mobile lumbar spine is particularly susceptible to injury♦ The role of decompression in spinal cord injury remains uncertain at level three or four evidence♦ Unstable fractures may be stabilized using modern fracture fixation methods enabling easier nursing care in polytrauma and earlier mobilization than non-surgical treatment♦ There is level two evidence that stable thoracolumbar fractures have similar outcomes with surgical and non-surgical treatment♦ There are many fracture classification systems that are not validated or have poor inter- and intraobserver error. Recent modern validated systems may in the future assist in the rational planning of interventions for spinal injury.