A one-stage anterilateral decompression of the thoracolumbar spine with Harrington rod alignment and posterior fusion has proven to be an excellent approach to the management of unstable fractures between T-11 and L-1. Twenty-six cases are reported in which this tactic was used to decompress neural structures and stabilize the spine. Preoperative computed tomographic scanning and somatosensory evoked responses (SSERs) are useful adjuncts in the patient's assessment. Intraoperative SSER studies have allowed monitoring to prevent an increase in the patient's neural deficit during operation. Intraoperative myelography is used to provide objective confirmation of the adequacy of the decompression of the spinal subarachnoid space. Satisfactory stability was achieved in all 26 cases reported in this series. Eight of 11 patients with partial neurological deficits returned to essentially normal function within 6 months. None of the patients who were neurologically intact (6 cases) or who had incomplete lesions (11 cases) was made worse by the operation. None of the 9 paraplegic patients regained spinal cord function, although a dramatic improvement in the function of the L-2 and L-3 roots occurred in 1 case. This approach to the management of unstable thoracolumbar fractures is useful, carries with it a low complication rate, and should be a standard part of the neurosurgical and orthopedic armamentarium.