Objective: To compare the effect of 270°and 360°spinal canal decompression with anterior and middle column reconstruction pedicle screw fixation in the treatment of severe thoracolumbar fractures. Methods: A retrospective study of 46 patients with severe thoracolumbar fractures from January 2010 to December 2016 was performed. According to the range of decompression, 19 cases were divided into 270°vertebral canal decompression group (A group) and 27 cases 36°spinal canal decompression group (B group). The operation time, intraoperative blood loss, postoperative drainage volume and allogeneic blood volume were recorded in both groups. The postoperative complications, bone graft fusion and the recovery of spinal cord nerve function were observed in both groups. Results: The operation was completed successfully. Postoperative follow-up ranged from 18 to 60 months, with an average of (41.34±10.41) months. There were no incision complications and no exacerbation of spinal cord neurological symptoms. The time of operation, the amount of blood lost during operation, the volume of blood drainage and the volume of allogeneic blood input in group A were less than those in group B, and the difference was statistically significant (P <0.05). The anterior height of vertebral body recovered 1 week after operation in both groups (P<0.05), and there was no significant loss in the last follow-up (P>0.05). The Cobb angle of injured vertebrae in both groups decreased 1 week after operation compared with that before operation (P <0.05), but there was no significant change in the last follow-up (P>0.05). The spinal canal occupation rate in the two groups decreased 1 week after operation (P <0.05), and decreased at the last follow-up week (P <0.05). There was no significant difference in Cobb angle and spinal canal occupation rate between the two groups after 1 week and the last follow-up (P>0.05). During the follow-up period, bone graft fusion and no failure of internal fixation occurred in both groups. At the last follow-up, 3 cases were grade A, 12 cases were grade B, 17 cases were grade C and 14 cases were grade D. Conclusion: For severe thoracolumbar fractures, posterior decompression and anterior middle column reconstruction of pedicle screw fixation, 270°and 360°spinal canal decompression can achieve complete decompression, and good clinical results are obtained, but 270°spinal canal decompression has short operation time. The advantages of intraoperative bleeding, postoperative drainage and allogeneic blood volume input and spinal stability damage are small.