Between 1973 and 1981, seventy patients with a spinal cord injury secondary to a thoracolumbar fracture were treated by anterior spinal-canal decompression through a retroperitoneal approach. All of these patients had an incomplete neurological deficit caused by retropulsed vertebral-body fragments and intervertebral disc material in the spinal canal. Forty-eight patients have been followed for an average of 3.4 years (range, two to 8.6 years). Either computed tomography or lateral tomography, or both, was performed after surgery on these forty-eight patients, and confirmed the successful removal of the cause of compression in all of them. No patient lost further cord or cauda equina function after the anterior decompression. Thirty-seven of the forty-two patients who had a motor deficit improved by at least one class in motor strength. Fourteen of the thirty patients whose quadriceps and hamstrings were too weak to permit walking regained full independent walking ability. Twelve of the thirty-two patients who had a conus medullaris injury demonstrated neurogenic bowel and bladder recovery. The degree of neurological recovery of spinal cord injury after anterior spinal decompression of thoracolumbar fractures appears more favorable than after other, previously reported techniques that do not decompress the spinal canal.