Objective To explore the efficacy of transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft for the treatment of severe compressed or burst thoracolumbar spinal fractures.Methods From January 2001 to January 2008,18 cases of severe compressed or burst thoracolumbar spinal fractures was treated with transpedicular fixation of spondylolisthesis and fracture(SF) or atlas fixation(AF) combined with mixed transpedicular structural and cancellous bone granule graft in the compressed vertebral body.Results In this group,no injuries to the spinal cord or nerves occurred.The mean blood loss was 50-300 ml(average 80 ml).The mean operation time was 100-180 min(mean 120 min),and the mean postoperative hospital stay was 12 to 30 days(14 days on average).Follow-up was available in 18 cases for a mean of 24 months(5-72 months),all the patients achieved satisfying recovery of the height and physiological curve of the vertebral body: 17 of the cases had normal height and physiological curve;in the other patient,the natural curve was partly destroyed;no patient had loosing and disrupted internal fixation.According to preoperative Frankel evaluation,1 case was classified as Frankel A,1 Frankel B;5 Frankel C,3 Frankel D,and 8 Frankel E before the operation;while postoperative classification showed 1 case of Frankel B;1 cases of Frankel C,and 16 cases of Frankel E.Conclusions Transpedicular fixation combined with mixed transpedicular structural and cancellous bone granule graft is safe and effective for the treatment of severe compressed or burst thoracolumbar spinal fractures.