[Objective] To compare the clinical efficacy of 3-pair pedicle screws with or without placement in the injured vertebrae for flexion-distraction thoracolumbar fractures. [Methods] A retrospective study was performed on 43 patients who received pedicle screw fixa- tion of flexion-distraction thoracolumbar fractures in our department from January 2017 to December 2020. According to the preoperative doctor-patient communication, 20 cases underwent 3-pair pedicle screws with non-placement in the injured vertebrae (PSNIV) , while the remaining 23 cases received 3-pair pedicle screws with placement in the injured vertebrae (PSIV) . The two groups were compared regard- ing perioperative, follow-up and radiographic documents. [Results] All patients in both groups received successful surgery with no injury to nerves. The PSNIV group had significantly longer incision than the PSIV (P＜0.05) , despite no significant difference in terms of operative time, intraoperative blood loss, intraoperative fluoroscopy and hospital stay between the two groups (P＞0.05) . Patients in both groups were followed up for 16~23 months, with an average of (19.6±5.2) months. There was no significant difference in the time to return walking and the time to resume full-weight bearing activity between the two groups (P＞0.05) . The ASIA grade for neurological function, as well as VAS, ODI and JOA scores improved significantly in both groups over time (P＜0.05) , whereas which proved not significantly different between the two groups at any matching time points (P＞0.05) . Regarding to radiographic assessment, the anterior vertebral height and lumbar lordosis of the two groups was significantly increased (P＜0.05) , while the local kyphotic Cobb Angle decreased significantly immediately postopera- tively and at the latest follow-up compared with those preoperatively (P＜0.05) . There was no significant difference in the above imaging pa- rameters between the two groups before operation (P＞0.05) . The PSNIV proved significantly superior to the PSIV in term of correction of the anterior vertebral height, lumbar lordosis and local kyphosis Cobb angle immediately after operation and at the latest follow-up (P＜0.05) . [Conclusions] Three-pair pedicle screws with or without placement in the injured vertebrae do achieve satisfactory clinical outcomes for flexion-distraction thoracolumbar fractures. In contrast, the 3-pair pedicle screws with non-placement in the injured vertebrae is better than the 3-pair pedicle screws with placement in the injured vertebrae in correcting kyphosis and maintaining the anterior vertebral height.