The relationship of spinal trauma and survival has been critically reevaluated and the results of providing an integrated trauma approach in caring for patients with spine trauma are presented. Diagnosis and treatment of thoraco-lumbar spine injuries with a bending injury mechanism (“flexion-distraction injuries”) is presented with the insights of recently gained research insights. The program concludes with a review of the complex care needs of patients who suffer from a spine injury while suffering from conditions which lead to a stiffening of the spinal column, such as ‘ankylosing spondylitis’, ‘disseminated idiopathic skeletal hyperostosis’ and ‘endstage degenerative disc disease with ankylosis’. From the Series:Seventh Annual Harborview Spine Symposium: Improving Outcomes of Spinal Injury