Abstract：Objective To evaluate the clinical and radiographic results of Wiltse approach and percutaneous approach pedicle screw fixation for the treatment of single level thoracolumbar fracture without neurological deficits. Methods A retrospective analysis was performed on 38 cases of single level thoracolumbar fracture without neurological deficits admitted to our hospital from April 2015 to October 2017. According to the approach of pedicle screw implantation, the patients were divided into Wiltse approach group (18 cases) and percutaneous group (20 cases). The incision length, operation time, intraoperative blood loss, intraoperative X-ray frequency and hospitalization time postoperative were compared between the two groups. The VAS score, ODI score, vertebral body height and kyphosis deformity of Cobb’s angle were also compared between the two groups at different postoperative time points. Results All 38 patients were followed up for 12 to 15 months. Both Wiltse approach group and percutaneous group showed significant improvement in the height and Cobb’s angle of the fracture vertebral body postoperative (P < 0.05), but the differences between the two groups were not statistically significant (P > 0.05). The length of incision, intra-operative blood loss, post-operative hospitalization time, VAS and ODI score at 1 week after surgery were less in percutaneous group compared with those of Wiltse approach group (P < 0.05). However, the intraoperative X-ray frequency、Intraoperative blood loss and operation time of percutaneous group were more than those of Wiltse approach (P < 0.05). There was no significant difference in VAS and ODI scores between the two groups at 3 and 12 months after surgery (P > 0.05). Conclusion Both Wiltse approach and percutaneous approach pedicle screw internal fixation could achieve satisfactory recovery of height and Cobb’s angle of the fracture vertebral body in the treatment of single level thoracolumbar fractures without neurological deficits. Although percutaneous approach increased X-ray frequency and operation time, it can significantly shorten post-operative hospitalization time, reduce surgical trauma and early postoperative pain.