The treatment of thoracolumbar burst fractures in the absence of neurologic deficit remains controversial. The present study is a retrospective analysis of 52 of these acute burst fractures among 104 cases of thoracolumbar burst fractures treated either operatively or nonoperatively. Results are expressed in terms of neurologic function, pain, work status, and complications. All patients who had surgical treatment and no unrelated disability returned to full-time work. Twenty-five percent of the patients treated nonoperatively were unable to return to work full time. Of the patients in the nonoperative group, 17% developed neurologic problems. Prophylactic stabilization and fusion of acute burst fractures without neurologic deficit have significant advantages over conservative management.