Abstract:[Objective] To compare the clinical outcomes of mono- segment (MS) pedicle screw fixation versus short- segment (SS) counterpart for minor thoracolumbar fracture. [Methods] A total of 62 patients admitted our department from January 2019 to July 2021 for minor thoracolumbar fractures were randomly divided into 2 groups. Of them, 32 patients received MS fixation of the injured vertebra with the upper or lower vertebra according to the fracture location, while the other 30 patients underwent SS pedicle screw fixation of the upper and lower vertebrae over the injured vertebrae. The document regarding to perioperative period, follow-up and images were compared be- tween the two groups. [Results] All patients in both groups had corresponding surgical procedures performed successfully without serious complications. The MS group proved significantly superior to the SS group in terms of operation time [(39.6±21.5) min vs (54.4±26.9) min, P＜0.05], length of incision [(8.6±2.4) cm vs (11.3±3.9) cm, P＜0.05], intraoperative blood loss [(79.2±53.2) ml vs (112.6±63.7) ml, P＜0.05] and postoperative walking time [(3.3±2.3) days vs (5.7±3.5) days, P＜0.05]. All patients in both groups were followed up for (16.3±4.5) months in a mean, and the MS group resumed full weight-bearing activity significantly earlier than the SS group [(28.5±11.2) days vs (40.1± 24.4) days, P＜0.05]. The VAS, ODI and JOA scores were significantly improved over time in both groups (P＜0.05). Although there was no significant difference in the above indexes between the two groups before surgery (P＞0.05), the MS group was significantly better than the SS group in VAS score 1 week after surgery [(2.4±1.5) vs (3.9±1.8), P＜0.05], and ODI score at the last follow-up [(10.9±2.4) vs (13.5±3.9), P＜0.05]. Regarding imaging, the anterior vertebral height (AVH), posterior vertebral height (PVH) and local kyphotic Cobb angle signifi- cantly improved at 1 week after surgery and at the last follow-up compared with those preoperatively (P＜0.05). There was no significant dif- ference in the above imaging indexes between the two groups before surgery (P＞0.05), whereas the MS group was significantly superior to the SS group in terms of AVH 1 week postoperatively [(98.4±12.2)% vs (91.7 ±10.2)%, P＜0.05], AVH at the last follow-up [(95.1±9.4)% vs (87.1±10.6)%, P＜0.05] and kyphotic Cobb angle [(2.3±5.8)° vs (5.9±7.4)°, P＜0.05]. [Conclusion] The mono-segment pedicle screw fixa- tion of minor thoracolumbar fracture has the advantages of small incision, less operation time and less intraoperative bleeding, and does achieve good stability and therapeutic effect over the traditional short-segment fixation.