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The low lumbar burst fracture occurs in a unique anatomic zone with distinct biomechanical features as compared to the more common thoracic and upper lumbar fracture. Several relative surgical indications for a low lumbar burst fracture exist and include the presence of neurologic deficit including acute radiculopathy with associated weakness or cauda equina syndrome, severe lumbosacral kyphotic deformity, or progression of deformity despite nonoperative treatment. The surgical management of the low lumbar burst fracture must be individualized based upon fracture anatomy, neurologic status of the patient, and sagittal plane alignment. Surgery offers the patient with neurologic compromise the best option for restoration of normal function.