Thoracolumbar fractures are common in high energy trauma patients and could be divided into compression fractures, burst fractures, flexion-distraction injury, and fracture dislocations. A comprehensive evaluation of the patient is crucial including end-to-end motor and sensation examination and possible associated injuries. The current treatment methods are still controversial. The goal of treatment is to restore proper alignment and mechanical stability, to induce neurological recovery, and to achieve early mobilization and rehabilitation. The stability of the spine, the neurological status, and the integrity of the posterior ligament complex (PLC) are the keys to determine the treatment policy. The role of percutaneous posterior fixation without arthrodesis increased in recent years. But it is still controversial for the use of these treatments and there is no verified evidence for long-term results yet. The necessity of decompression and the treatment methods in regards to the degree of neurologic injury is discussed as well. Generally, early decompression within 24 hours over incomplete spinal cord injury is recommended.