Abstract Background: Thoracolumbar spine fractures (traumatic & pathological) is a common vertebral pathology we face in our clinical practice. Neurological affection may occur with spinal cord compression. Both anterolateral and posterior approaches have been used to treat the condition. The ideal approach however is still not agreed on particularly when there is neurological affection due to spinal cord compression. Aim of Study: To compare the result of anterolateral versus posterior approach in decompression and stabilization of spine. Study Design: Prospective comparative study. Patients and Methods: This study was prospectively conducted on 30 patients with lower dorsal and upper lumbar spine fractures operated upon in the period from January 2016 to July 2017. In-depended student t-test used to compare measures of two independent groups of quantitative data. Paired t-test in comparing two dependent quantitative data. Results: The results of this thesis showed that in the surgical management of thoracolumbar burst and pathological fractures, the anterolateral approach was not significantly superior to the posterior approach in terms of significant recovery of neurological function, return to work and main-taining normal life activities. To some extent the anterior approach was better than posterior approach in rapid improve-ment of sphincteric control in patients with incomplete cord injury with sphincteric troubles. Conclusion: Good clinical evaluation of every case with exclusion of life threatening conditions and stabilization of the general condition of the patient is mandatory before proceeding in the definitive management of the spinal pathology.