[Objective] To compare the imaging and clinical results of percutaneous pedicle screw fixation (PPSF) combined with spinal canal decompression and reduction under Quadrant tube versus open pedicle screw fixation (OPSF) combined with laminectomy and decompression in the treatment of AO type A3 thoracolumbar fractures (TLF) with nerve injury. [Methods] From January 2018 to January 2020, 63 patients with single level AO type A3 TLF were retrospectively analyzed. 26 patients were treated with PPSF combined with decompression and reduction under Quadrant tube via posterior midline approach (the PPSF group); 37 patients were treated with OPSF combined with laminectomy and decompression (the OPSF group). The radiological data and clinical outcome were compared. [Results] The intraoperative blood loss and postoperative hospital stay in group PPSF were significantly better than those in group OPSF (P < 0.05), but the operation time was significantly longer than that in group OPSF (P < 0.05). The CK index of group PPSF was significantly lower than that of group OPSF at 1 week after operation (P < 0.05). During the follow-up, the VAS and ODI scores of group PPSF were significantly better than those of group OPSF, and the difference was statistically significant (P < 0.05); there was no statistically significant difference in the AVHR index of the two groups during the postoperative follow-up (P > 0.05), but the PVHR and Cobb angle indexes of local kyphosis of group PPSF were better than those of group OPSF, and the difference was statistically significant (P < 0.05). [Conclusions] PPSF combined with decompression and reduction of spinal canal under Quadrant tube via posterior midline approach exerts minimal trauma, fast postoperative recovery and satisfactory imaging indexes, which is minimally invasive, safe and effective.