[Abstract] Objective: To study the effect of pedicle screw internal fixation combined with spinal canal decompression on thoracolumbar fracture with nerve injury through posterior small incision under direct vision. Methods: 108 patients with thoracolumbar fracture and nerve injury in our department in recent two years were selected. The study group consisted of 52 patients who received posterior pedicle screw internal fixation combined with spinal canal decompression through small incision, and the control group consisted of 56 patients who received posterior open decompression and pedicle screw internal fixation. Two groups of patients were compared in terms of general surgical indicators, wound pain scores before and after treatment, imaging indicators before and after treatment, neurological function scores before and after treatment, and complications after treatment. Results: (1) The operation time, intraoperative bleeding volume, postoperative drainage and hospitalization time in the study group were significantly lower than those in the control group. (2) Before treatment, the difference of VAS score between the two groups was not significant (P > 0.05); after treatment, the VAS score of the study group was significantly lower than that of the control group. (3) Before treatment, there was little difference in imaging parameters between the two groups. After treatment, SCP and AVH in the two groups were significantly better than those before treatment, and CA was significantly lower than those before treatment. After treatment, SCP and AVH in the study group were significantly better than those in the control group, and CA was significantly lower than those in the control group. (4) Before treatment, the difference of JOA score between the two groups was small; after treatment, the JOA score of the study group was significantly better than that of the control group. (5) There were no complications after treatment in the study group and 2 in the control group. Conclusion: Pedicle screw internal fixation combined with spinal canal decompression through posterior small incision under direct vision has the characteristics of minimally invasive, safe and efficient. It is conducive to avoid surgical trauma, reduce subjective pain, ensure complete decompression, and have better image reduction and neurological function recovery effect. It is a treatment of thoracolumbar fractures with. It is suggested that further large-sample study and clinical popularization be carried out for the ideal surgical method of nerve injury.