Background: Thoracolumbar burst fractures represent one of the most frequent and challenging spine injuries.  While outcomes from tertiary centers are well documented, there is a paucity of evidence from district-level hospitals in low- and middle-income countries where resources are limited. This study evaluates surgical outcomes over six years from a single surgeon operating in a district hospital in Bangladesh, highlighting the factors that influence recovery despite infrastructural constraints.

Objective: To identify clinical, radiological, and treatment-related factors affecting outcomes of thoracolumbar burst fracture surgery performed in a resource-limited district-level setting.

Methods: A retrospective review was conducted of consecutive patients with thoracolumbar burst fractures (T10–L4) who underwent surgery between 2019 and 2025. Demographics, mechanism of injury, ASIA grade, time to surgery, fracture characteristics, operative details, and complications were recorded. Outcomes included neurological recovery, functional status (ODI/ambulation), radiographic parameters (kyphotic angle, canal compromise), and complications. Univariate and multivariable analyses were used to identify independent predictors of poor outcome.

Results: A total of 163 patients mean age 32 years; 62% male were included with a median follow-up of 9 months. Neurological improvement was observed in 92% of patients; mean kyphosis correction was excellent, at final follow-up. Independent predictors of poor outcome were delayed surgery >72 hours, severe preoperative deficit (ASIA A–B), canal compromise >50%, and age >60 years. Despite limited imaging, implants, and critical care support, complication rates remained within reported global ranges.

Conclusion: Thoracolumbar burst fracture surgery can achieve satisfactory neurological and radiological outcomes even in resource-constrained district hospitals. Timely surgery, early diagnosis, and pragmatic operative strategies are key determinants of success. These results underscore the importance of strengthening district-level spine care capacity in low- and middle-income countries.