A retrospective study of 100 cases with thoracolumbar fractures was performed to compare the results from different surgical approaches and to provide a guide line for surgical treatment. Fifty-three patients were operated through anterior approach and forty-two patients were through posterior approach. All patients were evaluated according to changes in the following parameters: kyphotic angles, compression heights, degrees of canal compromise, neurologic deficits, pain levels, delayed kyphosis and complications. There were no significant differences in kyphotic angles, compression heights, degrees of canal compromise, neurologic deficits, and pain levels between two approaches. Delayed kyphosis occurred in one(2.4%) of 42 cases treated by posterior approach and six(11.3%) of 53 cases treated by anterior approach. Dural lacerations were noted in fourteen(43.8%) of 32 cases associated with lamina fractures and were repaired in all of nine cases approached posteriorly but none of five cases approached anteriorly. In conclusion, posterior approach is simple, less extensive, is associated with lower incidence of delayed kyphosis and better dural repair than the anterior approach. Posterior approach could be, therefore, considered initially for those cases where surgery is indicated for thoracolumbar or lumbar fractures.