Abstract:[Objective] To investigate the effect of vertebral body edema extent on clinical outcomes of percutaneous pedicle screw fixa-tion (PPSF) for thoracolumbar fracture. [Methods] A retrospective study was done on 141 patients who received PPSF for thoracolumbarfracture treated from February 2018 to May 2021. [Results] According to the vertebral body edema extent in preoperative MRI images, thepatients were divided into three groups, including 55 cases in mild group, 52 cases in moderate group and 34 cases in severe group. Therewere no statistically significant differences in operation duration, intraoperative fluoroscopy times, total incision length, intraoperative bloodloss, success rate of first screw placement, incision healing grade, postoperative walking time and length of hospital stay among three groups(P＞0.05). The mean follow-up time was (18.5±2.4) months, and there was no significant difference in time to resume full weight-bearing ac-tivity among the three groups (P＞0.05). The VAS, ODI and JOA scores were significantly improved over time in all three groups (P＜0.05),whereas which were not statistically significant among the three groups at any time points accordingly (P＞0.05). As for images, there wereno significant differences in anterior vertebral compression rate (AVCR) and local kyphotic Cobb angle (KA) among the three groups beforeand immediately after surgery (P＞0.05), but all with statistically significant differences at the preoperative and the latest follow-up. [Conclusion] The severe vertebral body edema preoperatively might lead to delayed kyphosis deformity in long term after PPSF.