[Objective] To investigate the clinical effect of posterior osteotomy in the treatment of thoracolumbar vertebral kyphosis with old fracture.[Methods]A retrospective analysis was performed on 41 patients with old thoracolumbar fracture kyphosis treated by posterior osteotomy from September 2006 to June 2019, including 32 males and 9 females, with an average age of 42.3(24-71) years; The duration from the first fracture to this admission was 5-31 years, with an average of 14.56 years.Kyphosis Cobb's Angle (64.86±15.59)°.SPO osteotomy was performed in 7 patients, PSO osteotomy in 20 patients, BDBO osteotomy in 11 patients and PVCR osteotomy in 3 patients.VAS score, ODI function index, ASIA spinal cord function grade and motor function score, deformity correction rate and spinal cord function changes were statistically analyzed before, after and at the last follow-up to evaluate the efficacy.[Results] After 12-72 months of follow-up (mean 36.7 months),Cobb's Angle 12 months after operation was (13.96±3.56) , and the correction rate of kyphosis was 78.56%. Cobb's Angle (14.82 ±1.20) ° at the last follow-up showed no significant loss compared with 12 months after operation (P> 0.05). VAS score, ODI function index and ASIA spinal cord function score were significantly improved (P< 0.001), osseous union was found in all osteotomy ends 18 months after operation.[Conclusion]Posterior osteotomy for the treatment of thoracolumbar vertebral fracture kyphosis can achieve good orthopedic and spinal balance reconstruction, high osteotomy end fusion rate, fewer complications, and promote the recovery of spinal cord function.