The results of surgical decompression (SD) in 59 patients with neurologic deficits secondary to thoracic or lumbar fractures were evaluated at a mean of 3.7 years after injury. The purpose was to determine whether SD could be correlated with subsequent neurologic outcome. Follow-up neurologic evaluations showed a greater neurologic improvement in the 20 patients who were treated with anterior spinal SD as compared to the 39 patients who received posterior or lateral SD (88% vs. 64%). The return of normal bowel and bladder control also occurred more frequently in the anteriorly SD group than the posteriorly treated SD group (69% vs. 33%). The inferior results in the posteriorly treated SD group appeared to correlate with a high incidence of bony stenosis as measured on postoperative computed axial tomography.