Nicoll in 1949 classified thoracolumbar fractures into 4 types: anterior wedge fracture; lateral wedge fracture; fracture dislocation; and arch fracture. The stability of the interspinous ligaments was then determined by the integrity of the ligaments and the location of the fracture. Stable fractures are classified as anterior wedge fractures, lateral wedge fractures, and lumbar plate fractures above lumbar 4; unstable fractures are classified as all subluxation fractures with compound interspinous ligament injuries, fracture dislocations, arch fractures, and lumbar plate fractures of lumbar 4 (L4) and lumbar 5 (L5). In 1963, Holdsworth proposed the double column concept, i.e., the anterior column for the anterior longitudinal ligament, the vertebral body, its intervertebral disc and the posterior longitudinal ligament, and the posterior column for the posterior complex. And according to the posterior column damage or not, the thoracolumbar fractures are divided into two categories: (1), Class A: stable fractures, including wedge-shaped compression fractures and compression burst fractures. (2) Class B: unstable fractures, including dislocation, extension fracture dislocation, and rotation fracture dislocation. The old classification of thoracolumbar fractures could no longer meet the clinical needs as the understanding of seat belt fracture and the complexity of thoracolumbar fracture mechanism intensified in the 60s and 70s.Whitesides made a comprehensive classification of thoracolumbar fractures based on the concept of double column, which was divided into 2 categories and 7 types: (1), Category A: stable fractures, including compression fractures and stable burst fractures. (2) Class B: unstable fractures, including “slice” fractures, unstable burst fractures, flexion-distraction fractures, dislocations without fractures, and extension injuries. In the 1980s, with the increasing understanding of the mechanism of injury and the functional units of the spine in thoracolumbar fractures, Gumley et al. divided flexion and distraction fractures into three types based on the pathology of posterior column damage: (1) Type I: the fracture line enters the vertebral body horizontally through the spinous process, the vertebral plate, the transverse process, and the pedicle. (2) Type II: The fracture line enters the vertebral plate at the base of the spinous process through the intervertebral space, and the rest is the same as type I. (3), Type III: unilateral injury, the travel of the fracture line is roughly similar to Type I and Type II fractures. Subsequently, Gertzbein and CourtBrown classified the anterior column fractures and vertebral disruptions in flexion-distraction fractures, in which the anterior column fractures were divided into three major types, including: (1) Type A: transvertebral disc injury. (2) Type B: injury through the vertebral body to its anterior wall cortex. (3), type C1: injury through the upper endplate. (4), Type C2: injury via the inferior endplate. Vertebral disruption is also classified into 3 types, including: (1) Type D: wedge-shaped compression fracture. (2) Type E: burst fracture. (3) Type F: Vertebral body is intact. On this basis, a combined classification scheme for flexion-distraction fractures is provided by combining Gumley et al.’s staging of posterior column injuries. The Denis three-column concept further deepened the understanding of the structure of the spine and its functional units. The fractures of the thoracolumbar spine are classified into 4 major categories: (1) Category A: compression fractures. (2) Class B: Burst fracture; Class B is divided into 5 types: (1) Upper and lower endplate type; (2) Upper endplate type; (3) Lower endplate type; (4) Burst rotation type; (5) Burst lateral flexion type. (3) Class C: Safety belt fracture; Class C fracture is divided into single horizontal and double horizontal fracture line, each type has bony injury and soft tissue injury, combined into 4 types. (4), Class D: fracture dislocation. There are three types of Class D: (1) flexion-rotation fracture dislocation; (2) shear fracture dislocation; and (3) flexion-distraction fracture dislocation. Therefore, McAfee et al. classified thoracolumbar fractures into 6 major categories based on the CT manifestations of thoracolumbar fractures and the status of the middle column forces: (1) wedge compression fractures; (2) stable burst fractures; (3) unstable burst fractures; (4) Chance fracture; (5) flexion-distraction injury; displacement injury. Among the displaced injuries are “slice” fractures, rotational fracture dislocations, and simple dislocations. Since the 1990s, in view of the shortcomings of the existing classification of thoracolumbar fractures, the AO school and the American orthopaedic authorities have introduced their own classification methods. (1) Class A: vertebral compression: ①A1: compression fracture; ②A2: split fracture; ③A3: burst fracture. (2), Class B: distraction bicolumn fracture: ①B1: ligament-based posterior column injury; ②B2: bony-based posterior column injury; ③B3: injury by anterior transvertebral disc. (3), Class C: rotational two-column injury: ①C1: Class A fracture with rotation; ②C2: Class B fracture with rotation; ③C3: Rotation 2 shear injury. The classification proposed by Gertzbein on behalf of the American orthopedic authority is 3 categories and 9 types, namely: (1), category A: compression type, including extrusion type (wedge), cleavage type (coronal), burst type (complete burst). (2), Class B: tension type, including posterior soft tissue type (subluxation), posterior arch type (Chance fracture), anterior disc type (extension slippage). (3), Class C: multi-directional displacement, including anterior-posterior type (dislocation), lateral type (lateral shear), rotational type (rotational dislocation). In China, Zhang Guangbo et al. classified thoracolumbar fractures based on the Denis classification, focusing on three-column injuries and supplemented by the condition of spinal canal obstruction. Rao Shucheng combined several common classifications to classify thoracolumbar fractures into five major categories: (1) flexion compression fractures, of which the typology was classified into three types using Ferguson and Allen’s third degree compression classification. (2) Burst fractures, of which the typing is based on the five types of burst fractures classified by Denis. (3) Flexion-distraction injury, in which the typing is based on the Gertzbein’s classification of flexion-distraction fractures from A to C2. (4) Flexion-rotation fracture dislocation, of which there are two types: transvertebral disc dislocation and “slicing” fracture. (5) Shear subluxation. The Spine Trauma Study Group (STSG) in the United States has recently proposed a new method for typing thoracolumbar injuries—Thoracolumbar Injury Scoring System (TLISS). The TLISS scoring system is based on three main aspects: (1) understanding the mechanism of injury based on imaging data. (2), the integrity of the posterior ligamentous complex structure of the vertebral body. (3), the neurological functional status of the patient. Each item was scored separately and summed to obtain the total TLISS score, which was used to develop the treatment strategy. The STSG later improved the TLISS by replacing the subjective mechanism of injury with a more objective description of the fracture pattern, and called the Thoracolumbar Injury Classification and Severity Score (TLICS). The specific criteria are: (1), the morphological performance of the fracture: 1 point for compression fracture; 2 points for burst fracture; 3 points for rotational fracture; 4 points for distraction fracture. In case of duplication, the highest score was taken. (2), integrity of the posterior ligamentous complex structure of the vertebral body: 0 points for intact; 3 points for complete fracture; 2 points for incomplete fracture. (3), the patient’s neurological functional status: 0 points for no neurological damage; 2 points for complete spinal cord injury; 3 points for incomplete injury or cauda equina syndrome. The sum of the scores is the total TLISS score. The system recommends that those with scores greater than or equal to 5 should be considered for surgical treatment, those with scores less than or equal to 3 should be considered for non-surgical treatment, and those with scores of 4 can choose surgical or non-surgical treatment.