To investigate the unique characteristics and treatment of thoracic spine fractures.Seventy-seven patients with thoracic spine fractures were retrospectively reviewed. Of these, there were 37 compression fractures, 34 fracture-dislocations, 3 burst fractures and 3 burst-dislocations. Twenty-six patients had a complete lesion of the spinal cord, 14 sustained a neurologically incomplete injury, and 37 were neurologically intact. Fifty-three patients were treated nonoperatively and 24 treated operatively.All patients were followed up for 2 approximately 15 years. None of the 26 patients with a complete lesion recovered any significant function. Of 37 neurologically intact patients, 13 had local pain although all of them remained normal function. Two of 14 patients with incomplete paraplegia returned to normal, 7 recovered some function and 5 did not recovered.Because of the unique anatomy and biomechanics of the thoracic spine, the classification commonly applied to thoracolumbar fractures is not suitable for thoracic fractures. Fusion and instrumentation are indicated when the fractures are unstable, while patients with incomplete lesion of the spinal cord may be the candidates for supplemented decompression.