90 patients with thoracolumbar fractures were randomized to receive one of three surgical interventions: three-level percutaneous fixation, two-level percutaneous fixation, or three-level open fixation. The purpose of this study was to compare clinical and radiological outcomes of these three procedures after a mean follow-up of 17.7 months. Results demonstrated comparable postoperative Cobb angles, anterior height ratios of fractured vertebrae, and correction loss between all three groups. However, patients in the three-level percutaneous fixation were observed with significantly reduced back pain scores and intraoperative blood loss when compared to three-level open fixation.