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Thirty-eight patients with unstable thoracolumbar and lumbar (T12–L5) spine fractures were treated with Cotrel-Dubousset pedicle screw instrumentation. They were followed for an average of 22.73 months (range 12–39). Measurements of canal compromise. wedge index, and kyphosis correction at follow-up examination were made. Thirty-three (86%) patients responded to a questionnaire concerning overall satisfaction, use of pain medication and return to work. There was an overall correction of kyphosis at follow-up of only one degree after a loss of six degrees from operative correction. There were nine cases of bent or broken screws that occurred at the thoracolumbar junction. Only one patient with instrumentation required continued pain medication and most had returned to work. Thirty-two of thirty-three patients were satisfied with the overall surgical result and twenty-eight of thirty-three patients had returned to work.