Background: Despite the great evolution in neurosurgical techniques, management of fractures of the thoracic spine still represent a major conflict in neurosurgery due to the different causes leading to fracture and the different methods available for management. The thoracolumbar region anatomically from D11-L2 which loss the stabilization effect of the rib cage. The spinous processes are more horizontal, which provides increase mobility. Objective: The aim of this study is to evaluate the efficacy and success of posterolateral approach for treatment of dorsal spine fractures surgically. Patients and methods: This was a prospective study of 30 patients of both sexes having all types fractures in the dorsal region (whether traumatic or pathologic) managed in the period between October 2015 and September 2017 in Neurosurgery Department Minia and Al-Azhar University hospitals. The study was approved by the medical ethics committee of Minia and Al-Azhar University Hospitals and a written informed consent was obtained from all patients. Results: Among the 30 patients, 14 of them managed by transpedicular screws fixation, 11 patients managed by costotransversectomy with pedicular screws fixation, and 3 patients managed by costotransversectomy with pedicular screws fixation and interbody cage insertion while one case managed by LECA with pedicular screws fixation and another one case with LECA with both pedicular screws and interbody cage insertion. Among the 30 patients managed 25 of them improved and 5 patients did not show any improvement during management. Conclusion: The ideal methodology in managing fractures should be meticulous pre-operative, operative, and postoperative management. The preoperative management should entail detailed and through clinical neurological evaluation to point out the presence of preoperative neurological deficit and their extent.