Lower lumbar spine fractures (LLSFs), involving the L3–L5 vertebral levels, are complex injuries that typically result from high-energy trauma or conditions such as osteoporosis that compromise bone integrity. This spinal region is biomechanically critical due to its substantial load-bearing function and wide range of motion. Consequently, the diagnostic and therapeutic management of LLSFs requires a carefully structured, multidisciplinary approach. Patient age, trauma mechanism, associated injuries, neurological status, and fracture morphology are key determinants guiding treatment decisions. This review provides a comprehensive overview of the clinical diagnosis of LLSFs, radiological assessment methods (CT and MRI), commonly used classification systems (particularly Denis and AO Spine TLICS), and both conservative and surgical treatment strategies. Stable fractures without neurological impairment may be managed nonoperatively through bed rest, pain control, and thoracolumbosacral orthosis (TLSO) bracing. In contrast, surgical intervention becomes necessary in cases of instability, risk of progressive deformity, or significant neurological deficits. Posterior instrumentation remains the most frequently employed technique; however, anterior, lateral, and minimally invasive approaches are also viable options depending on patient- and fracture-specific characteristics. In conclusion, optimal management of LLSFs requires an individualized, evidence-based, multidisciplinary, and patient-centered treatment strategy, enabling achievement of both short-term and long-term structural and functional recovery goals.