PURPOSE: To examine the relationship between injury severity and patterns of associated injury in spinal fracture. MATERIALS AND METHODS: From March 2004 to March 2010, a retrospective study was conducted on 291 patients who had undergone surgeries due to spinal fractures. Spinal fractures were categorized as upper cervical, lower cervical, thoracic, thoracolumbar, and lumbar region, and the severity of fracture was measured using the Abbreviated Injury Scale and Injury Severity Score (ISS). We evaluated the correlation between the fracture site and the incidence and injury severity of the associated injury, and compared the neurologic damage according to the presence/absence of the associated injury. RESULTS: Spinal fracture occurred in the thoracic (43.5%) and lower cervical (30.0%) levels, and associated injury developed in 134 patients (47%). The area of associated injury was in the extremity (41.2%), thorax (25.5%), head, neck, and face (21.9%). Lower cervical fracture (34.5%) had a lower prevalence than thoracic (81%) and lumbar fracture (61%). The average ISS of the associated injury was 17.14 for the thoracic fracture, 12.30 for the lower cervical fracture, 8.7 for the thoracolumbar fracture and 5.69 for the lumbar fracture. Neurologic damage was highly frequent in the lower cervical fracture and included 54 patients (62.1%) and was less frequent in the upper cervical fracture, which included 7 patients (17.9%) (p=0.032). CONCLUSION: Although the associated injury was less frequent in the lower cervical spine among the spinal fractures that underwent surgical treatment, there was a high risk of neurologic damage in the case of associated injury; therefore, there is a need to pay special attention to patients that suffer damage in this area. In addition, since the degree of the associated injury in the thoracic and lower cervical fracture is significant, an appropriate management strategy for the associated injury must be considered.