Thoracolumbar burst fractures are high-energy vertebral injuries, which commonly can be treated nonoperatively. Consideration of the injury pattern, extent of comminution, neurological status, and integrity of the posterior ligamentous complex may help determine whether operative management is appropriate. Several classification systems are contingent upon these factors to assist with clinical decision-making. A multitude of operative procedures have been shown to have good radiographic and clinical outcomes with extended follow-up, and treatment choice should be based on the individual's clinical and radiographic presentation.