Objective To discuss causation and clinical treatment of complication in anterior decompression and fixation technique (ADFT) for thoracolumbar fractures with associated paraplegia. Methods A total of 204 cases that had thoracolumbar fractures with paraplegia were operated with ADFT from 1998 to 2004. Of all, 51 times (34 cases) of complication took place. Change of Cob angle was measured according to X-film of thoracolumbar spine before and after operation. Meanwhile, sensation and motion of patients was evaluated. Results There was incision infection leading to septic cerebo-meningtis in one case, CSF leakage in seven, pneumothorax in eight, rib nerve-root injure in five, lumbar nerve-root injure in two, genitofemoral nerve injure in three, lateral femoral cutaneous nerve injure in two, kyphosis in three, deep venous thrombosis in three and eight times of skin-temperature change. X-film that was taken after operation for all patients showed scolisis in five cases. A follow up for 3-6 years (average 2.5 years) was performed in 84 cases, of which seven cases had chronic low-back pain, six scolisis and five kyphosis. No patient showed complications such as screw breakage, plate breakage, fixation device loosening and pseudo-articulation in thoracolumbar spine. Conclusions Many complications can be avoided if we master well anterior decompression and fixation technique of thoracolumbar fracture, reduce surgical trauma and give appropriate and rational guide for rehabilitation.