SummaryInstrumentation failure in the surgical treatment of thoracolumbar spine fractures can usually be avoided with detailed preoperative planning, thorough understanding of the injury, and careful technique. However, even with appropriate instrumentation selection and application, loss of fixation or need for revision occur. Revision of internal fixation of the spine is a complex undertaking. Successful revision with modern posterior segmental instrumentation systems usually requires extension of the instrumented area to use new anchor sites. Specialized instrumentation may be required especially if extension to the pelvis or cervical spine is needed. With careful technique, stabilization of the spine can usually be achieved.