Flexion-distraction injuries, also known as chance fractures, occur when the middle and posterior columns fail under tension, the anterior column fails under compression, and the PLC is disrupted. Isolated bony chance fracture can be treated nonsurgically with a hyperextension cast or orthosis for 3 months. However, comparative studies report worsening kyphosis, pain, and functional outcomes compared with surgery. Neurologically intact patients, polytrauma, or patients who are unable to tolerate external immobilization are candidates for MISS without fusion.