spine instetesting cases, ortho rare case, spine unique case, pg teaching case, spine exam case.Thoracolumbar Burst Fractures are a common high-energy traumatic vertebral fractures caused by flexion of the spine that leads to a compression force through the anterior and middle column of the vertebrae leading to retropulsion of bone into the spinal canal and compression of the neural elements. Diagnosis is made with radiographs of the thoracolumbar spine. CT scan is useful for fracture characterization and surgical planning. Treatment is bracing or surgical decompression and stabilization depending on whether the patient has neurologic deficits and whether the facture is unstable with a risk of drifting into kyphosis. pathoanatomy at thoracolumbar junction there is fulcrum of increased motion that makes spine more vulnerable to traumatic injury burst fractures typically occur between T10-L2 (thoracolumbar junction) neurologic deficits canal compromise often caused by retropulsion of bone maximum canal occlusion and neural compression at moment of impact tissue recoiling post-injury can minimize the extent of displacement retropulsed fragments resorb over time and usually do not cause progressive neurologic deterioration deficit type location of stenosis relative to conus determines spinal cord injury conus medullaris syndrome neurogenic claudication due to stenosis distal to conus.Thoracolumbar Injury Classification and Severity Score injury characteristic qualifier points injury morphology compression (+1 point) burst (+2 points) rotation/translation (+3 points) distraction (+4 points) neurologic status intact (0 point) nerve root (+2 points) incomplete Spinal cord or conus medullaris injury (+3 points) complete Spinal cord or conus medullaris injury (+2 points) cauda equina syndrome (+3 points) posterior ligamentous complex integrity intact (0 point) no interspinous ligament widening seen with flexion views. MRI shows no edema in interspinous ligament region suspected/indeterminate (+2 points) MRI shows some signal in region of interspinous ligaments disrupted (+3 points) widening of interspinous distance seen TLICS treatment implications score < 4 points nonsurgical management score = 4 points nonsurgical or surgical managment score > 4 points surgical management indicated Presentation History high-energy mechanism axial-loading and flexion mechanisms fall from height (e.g. fall from deer hunting stand, fall from ladder, etc.) high-speed motor vehicle collision