The wide spread availability of computerized tomography has added a new dimension to the anatomical evaluation of vertebral fractures. This diagnostic modality has shown that in these fractures, the protrusion of bone spicules into the spinal canal is often encountered. The clinical significance of this finding and its relation to the need of establishing indications for surgery in these patients is controversial. The neurological outcome of patients with postraumatic bony encroachment of the spinal canal is not well documented in the literature, and therefore the adequate therapeutic approach is neither clear nor is it unanimous. Whether treatment should be aggressively surgical with decompression and/or segmental fusion, or conservative, the goal has to be prevention of secondary injury to the spinal cord. This presentation is a mean 4 year follow up study of 38 consecutive patients with spinal fractures and spinal canal narrowing, who were treated conservatively. The results demonstrate that the initial neurological findings have a very significant prognostic value for the neurological outcome, regardless of the spinal segment involved, the type of injury and spinal canal narrowing as demonstrated by computerized tomograms. We conclude that in trauma patients with vertebral fractures and spicules in the spinal canal without evidence of an initial neurological deficit, a favorable neurological prognosis can be predicted, following conservative management.