CT scans of 73 patients with acute thoracic/lumbar spine injuries from T3 to L5 were reviewed. Injuries were classified as burst fractures (48), fracture-dislocations (ten), wedge compression fractures (11), and seatbelt-type injuries (four). Thirty-one (42%) had motor deficits due to spinal cord or nerve root damage. Such neurologic deficits were present in all patients with fracture-dislocations, and 60% of those with burst fractures. Seven patients, four initially normal, developed progressive neurologic impairment early after injury. Burst fractures, one with dislocation, were the spinal injury associated with each progressive deficit. Burst fractures at T12 or L1 with 50% or more decrease of the mid-sagittal neural canal diameter had a significant risk of neurologic involvement, and of progressive deficit. CT scans demonstrate vertebral column damage well, and help identify those patients at risk of acute neurologic compromise.