Thoracolumbar spine fractures are common and can be difficult to diagnose. Many of these fractures are associated with extraspinal injuries and are subtle on imaging further contributing to diagnostic delay or misdiagnosis. Missed fractures are associated with increased neurologic injury and resulting morbidity. Careful and thorough workup of the multitrauma patient with dedicated spinal imaging is necessary to identify these injuries. This article reviews the major thoracolumbar spine fractures and imaging findings with attention drawn to subtle and easily overlooked features of these injuries.