Purpose of the review Thoracolumbar spine fractures often result in prolonged hospitalization and significant disability. Yet, a variety of surgical treatment options are available for each specific injury, and the optimal technique is not always evident. The following review summarizes the recent advances in the surgical treatment of thoracolumbar spine fractures. Recent findings The first decision that a surgeon must make is whether surgical treatment is best. Recently, a new classification system has been developed, and validated, to aid in the decision of operative and nonoperative management. Choosing the best surgical procedure also can be quite challenging. Techniques gaining popularity in the past year include short segment fixation, surgical stabilization without fusion, and minimally invasive stabilization. Summary Recent advances in the surgical treatment of thoracolumbar fractures will allow the surgeon to more certainly predict which patients will benefit from surgical intervention and then effectively treat the injury with the least invasive and debilitating procedure. The benefit of nonfusion surgical treatment, though promising, is still unclear and requires further research. © 2008 Wolters Kluwer Health|Lippincott Williams & Wilkins.