Spine fractures range from painful compression fractures, often seen after minor trauma in osteoporotic patients, to more severe injuries such as burst fractures and fracture-dislocations which occur following auto accidents or falls from height. Maintenance of mechanical integrity which depends on the type of fracture and the degree of instability. Stable fractures can usually be treated with bracing and rest. Unstable fractures usually require closed or surgical reduction to realign the bones and prevent spinal cord or nerve injury and facilitate nursing and rehabilitatory measures. Various fixation systems are available; the choice of stabilization depends on the surgeon’s familiarity. Partial neurological injuries will likely improve if bony decompression is performed when impingement of the neurological structures is identified. When disruption of vertebral elements has occurred through soft tissue and ligaments, the potential for stable healing is diminished and operative stabilization should be considered. Even with optimal management, significant long-term sequelae in the form of loss of function and persistent pain will be present in many patients following injury. Treatment of fractures in the pediatric population must be individualized.