Burst fracture of the low lumbar spine are rare and have not been well delineated in the literature. Thirty-one low lumbar burst fractures (L3-L5) were treated from 1981 through 1989. Average follow-up for 27 of the 31 patients was 46 months. Persistent complaints of back pain seemed to be found more in patients with long instrumentation and fusion and in patients with loss of lordosis. Conservative treatment of low lumbar burst fractures with body cast is a viable option in the neurologically intact patients with minimal height loss and minor angulation. If surgery is chosen, short rigid instrumentation (eg, transpedicular device) is best in accomplishing shorter fusion, maintaining vertebral height, and restoring lumbar lordosis. Harrington distraction rods improve vertebral height but produce loss of lumbar lordosis. Luque rods do not restore vertebral height and are only moderately effective in restoring lumbar lordosis. If patients are neurologically impaired in association with low lumbar burst fractures, posterior decompression by laminotomy or a transpedicular approach is generally effective. Maintaining vertebral height and restoring lumbar lordosis may be important in the prevention of disability from back pain.