Compared with the thoracolumbar spine (T11-L2), the lower lumbar region (L3-L5) has special anatomical features and biomechanical characteristics, and the chance of clinical fracture is smaller, and the clinical manifestations, treatment outcome and prognosis after fracture are all special. A total of 32 such patients were admitted to the Department of Spine Surgery at the Chinese Rehabilitation Research Center from 1996 to 2006, with a total of 28 cases with complete clinical data, including 22 males and 6 females, with an average age of 31.6 years (12-63 years). Our department admitted 1519 patients with spinal fractures during the same period, including 640 patients with fractures of the thoracolumbar segment. Lower lumbar spine fractures accounted for 2.1% of all spine fracture patients and 5% of thoracolumbar segment fractures. The lower lumbar spine (L3-L5) is surrounded by strong iliolumbar ligaments and more paravertebral muscle coverage, and is protected by the pelvic ring and iliac crest, so its chance of fracture is much less than that of the thoracolumbar spine. Burst fractures of the 5th lumbar vertebra account for approximately 1.2% of all spinal fractures and 2.2% of the incidence of fractures of the thoracolumbar segment. In contrast, the exact incidence of lower lumbar fractures has not been clearly reported in the literature. In this paper, we reviewed the clinical data of our department in the past 10 years and admitted 32 such patients, accounting for approximately 2.1% of all spinal fractures and 5% of all thoracolumbar fractures admitted during the same period. However, the incidence of lumbar 5 fractures was relatively low in this group of patients, accounting for 21% of burst fractures, and lumbar 4/5 fracture dislocations accounted for 40% of the fracture dislocation group. Involvement of the segment was most common in lumbar 3, which accounted for 57% of the burst fractures. This result is generally consistent with the findings of Eric A et al. This may be related to the proximity of lumbar 3 to the thoracolumbar segment of the spine and its high position and lack of protection from the iliac crest. The vertebrae above lumbar 2 have a certain tendency to become posteriorly convex at an angle, while the body’s line of force is generally located anterior to the center of the vertebrae in the thoracolumbar segment, so axial loads and flexion violence are prone to produce a posterior convex deformity in the thoracolumbar segment of the spine. The lumbar 3 vertebrae are located at the apex of lumbar lordosis, and even if the lumbar vertebrae are in flexion, the entire lower lumbar spine has a certain tendency to be anteriorly convex. Moreover, the body’s line of force is generally located above or behind the center of the lower lumbar vertebrae, so the axial load acting on the lower lumbar vertebrae is less likely to produce a kyphotic deformity. These characteristics can also be seen in our group of cases, where even in severe burst fractures or fracture dislocations, the localized fracture rarely shows a kyphotic deformity, and this tendency does not change over time and is independent of the choice of treatment. There were no cases of significant loss of anterior convexity angle in the patients followed up. The lower lumbar region houses the cauda equina, which is similar to the peripheral nerve in terms of functional recovery after injury. Injury to the cauda equina occurs more often due to a sharp increase in pressure in the spinal canal at the time of injury rather than compression of the bone mass after injury. Therefore, most studies have shown that there is no necessary correlation between the degree of nerve injury and the rate of spinal canal occupancy. In our group, there were two cases with nearly 90% spinal canal occupancy, but the patients either had only radicular injury or eventually recovered to grade D. In contrast, the thoracolumbar spinal canal houses the conus or spinal cord, so the therapeutic effect of surgical decompression would seem to be more certain. Although there was no postoperative exacerbation of nerve injury in this group, the current debate on the indications for surgery for lower lumbar fractures seems to be more intense than for thoracolumbar fractures.Finn CA et al. showed good results in patients with burst fractures of the 5th lumbar vertebrae who were ambulatory for 2 weeks with bracing and no cases of loss of anterior convexity or exacerbation of nerve injury.Eric A in compared the results of surgical and non-surgical treatment of lower lumbar burst fractures and found that surgical treatment did not yield better results than conservative treatment, but rather had a higher reoperation rate (41%). However, 36% of the cases in this group were fracture dislocations and 50% were burst fractures, so a higher percentage of patients, 82%, received surgical treatment. Currently, most clinicians still prefer surgical treatment for cases with severe spinal instability and progressive worsening of neurological function due to triple column injury. For patients with multiple fractures or those who cannot tolerate bracing for various reasons, surgery is also recommended from the perspective of early rehabilitation to reduce complications. However, most of the literature supports a conservative approach for cases without nerve injury, with mild local deformity and less severe intracanal occupancy. Another issue of note is that patients with lower lumbar fractures often have multiple fractures in combination, with fractures of the other lumbar spine and lower extremity fractures being the most common. Although most fractures of the other part of the lumbar spine are relatively stable compression fractures or accessory fractures, for patients requiring surgery, the holding power of the pedicle nail at this segment should be fully considered and the fixed segment should be extended if necessary. At the same time, this group of cases showed that all such patients have good walking ability, so the combined lower extremity fractures must be properly managed to avoid affecting the patient’s future walking ability.