For stabilization of the lower thoracic and lumbar spine, an external spinal skeletal fixation (ESSF) system has been developed and clinically used since 1977. The system consists of two pairs of Schanz screws and an adjustable external fixation device. The Schanz screws are firmly anchored through the pedicles into the vertebral bodies. Application of ESSF offers some unique characteristics beneficial in the treatment of unstable spinal injuries and spinal osteomyelitis. In contrast to other fixation systems, the number of vertebrae immobilized can be reduced with ESSF. Versatility of the system allows application in every type of spinal instability. Stability obtained with ESSF suffices for early mobilization without major external support in every instance. In laboratory investigation, ESSF proved to be more secure than rod distraction systems and plate fixation. Since 1977, 65 patients were treated with ESSF. All 52 patients who were at least one year postsurgery were personally examined. This group included 42 patients with acute spinal trauma and eight patients with spinal osteomyelitis. Results achieved with ESSF have been encouraging, with no serious complications to date. Future modifications of ESSF application could lead to simplification and facilitation of treatment.