Objective: To evaluate the effectiveness of different surgical strategies in complicated thoracolumbar spine injuries, focusing on early decompression and stabilization, and to propose diagnostic and treatment algorithms applicable in modern clinical practice.

Background: Thoracolumbar junction injuries represent one of the most severe spinal traumas, frequently associated with neurological deficits and instability. Optimal surgical timing and choice of approach remain controversial, especially in patients with spinal cord compression and canal stenosis.

Methods: A total of 176 patients (aged 20–65 years) with complicated thoracolumbar trauma (Th10–L2) were retrospectively analyzed. Mechanisms of injury included falls from height (112 cases) and motor vehicle accidents (64 cases). Clinical and diagnostic evaluation consisted of neurological examination, radiography, CT, MRI, ultrasound, EMG, and myelography. Surgical interventions were classified according to the approach (posterior decompression with stabilization vs. stabilization alone). Outcomes were assessed based on neurological recovery and postoperative complications.

Results: Among the cohort, 32 patients had no neurological deficit, 123 presented with paraparesis, and 21 with paraplegia. Posterior decompression with early stabilization (within 24 h) showed significantly better neurological outcomes compared with stabilization alone (p < 0.05). The degree of canal stenosis (30–50%) correlated with the severity of deficit. No severe postoperative complications were observed. Comparative analysis with published data revealed similar trends but highlighted the importance of early decompression in patients with progressive neurological impairment.

Conclusion: Early posterior decompression and stabilization provide optimal outcomes in complicated thoracolumbar injuries with spinal cord compression. Based on clinical data and literature review, we propose structured diagnostic and surgical algorithms to support decision-making in such patients.

Keywords: thoracolumbar spine injury, spinal cord compression, decompression, stabilization, surgical algorithm, spinal trauma