Sixteen patients with "unstable" burst fractures of the thoracolumbar junction were treated with a modified posterolateral decompression and Harrington rod instrumentation. Preoperative computed tomography (CT) could assess the midsagittal diameter of the spinal canal and accurately localize the site of neural impingement. A surprisingly large proportion of cases had CT-demonstrated posterior element fractures which were missed using conventional radiographic modalities. The surgical goal was to provide the optimal environment for neurologic recovery. All 12 patients with neurologic deficits improved postoperatively, including five of eight patients with conus medullaris lesions who had full recovery. One-stage decompression-stabilization reduces the incidence of progressive kyphosis, neurologic deterioration, and mechanical back pain common in both conservative treatment and with wide laminectomy.