The most common site of spinal fractures is encountered at thoracolumbar region. These fractures which usually occur as a result of high energy traumas are serious injuries. Treatment of these fractures has been discussed for a long time. In the historical process, while some authors advocated advantage of non-surgical treatment, some others defended surgical treatment. Leaving aside the discussions on the issue of deciding in which cases surgical canal decompression is necessary, there is an ongoing debate on timing of surgery and surgical technique from the past to our time. There is not a definitive evidence that early surgical decompression and stabilization increases, or delayed surgery for a few days reduces neurological recovery. There is a consensus on early surgical intervention in case of progressive neurological deficit but it is controversial for complete or static incomplete injuries. The issue on surgical timing is accepted as a limit of 24 and 72 hours after injury. Successful results were reported with decompressions performed before both time periods. For this reason, the acceptable maximum time for early surgery can defined as 72 hours after the injury. Neural structures compressed by posteriorly displaced fragments can be relieved by indirect or direct decompression surgery. Successful results by indirect reduction through posterior instrumentation has been reported. But, this technique is not possible for complicated and delayed cases. Direct decompression can be performed via anterior, posterior, and combined methods. Each technique has own advantages and disadvantages. No one has superiority to each other in terms of neurological recovery. However, posterior decompression can be preferred because of the shorter duration of surgery, less blood loss, and greater surgical experience.