Posterior surgery is the traditional procedure for the treatment of thoracolumbar fractures. The posterior approach to arch root internal fixation, through the arch root to achieve three-column fixation, can be used for thoracolumbar fractures by using the ligamentous correction principle, that is, by restoring the tension of the anterior and posterior longitudinal ligaments of the spine and the intervertebral fibrous ring to restore the height of the compressed or burst injured vertebrae and achieve the effect of repositioning. Posterior surgery should generally consider the need for decompression of the vertebral plate and whether short or long segmental fixation is required. Simple arch internal fixation without posterior spinal canal decompression is feasible in the following cases: (1) compression fractures with 50% loss of height of the vertebral body front and 20% occupancy of the spinal canal; (2) preoperative CT and MRI confirm the integrity of the posterior ligamentous complex structure of the vertebral body; (3) no manifestation of neurological impairment of the spinal cord. For burst fractures or jump fractures with severe dislocation, posterior reduction and long segment (3-4 pairs of pedicle nails) fixation is adopted to increase their stability; separate posterior reduction and implant fusion (intervertebral fusion/posterior fusion) can also be used. Case 1: The patient, male, 44 years old, was admitted to the hospital with “back pain due to fall injury for 2 hours”. The patient fell from a high place 2 hours before admission and landed on his buttocks, and immediately felt lumbar pain, which was continuous and not severe in nature. The pain improved slightly after lying down and resting. He came to our hospital for emergency treatment, and the lumbar spine plain film showed “L2 vertebral body fracture”, and was admitted for further treatment. Physical examination: physiological curvature of the spine existed, and there was no obvious lateral convexity. The range of motion of the lumbar spine was reduced, and there was no obvious pressure pain in the spinous processes of the lumbar vertebrae. The lumbar spine had bilateral paravertebral muscle tension. Sensation in both lower limbs was normal. Muscle strength was grade V. Tendon reflexes were normal bilaterally. Bilateral pathological signs were not elicited. Secondary examination: lumbar spine X-ray showed “L2 vertebral fracture”, CT examination: L2 vertebral compression fracture. Postoperative photos: Case 2: 2 nail single-segment fixation Female, 53 years old, admitted with L3 vertebral fracture after a fall, imaging and postoperative imaging, radiographs after removal of internal fixation. Case 3 Male, 37 years old, L1 fracture after trauma, single-segment additional unilateral injured spinal screw fixation (5 nails) to improve the rate of fracture repositioning and increase the stability of the fractured segment, the patient recovered well after the operation. Case 4 5-nail reduction Male, 45 years old, L1 fracture with T12 spinous process fracture, posteriorly repositioned single segment with additional unilateral injury screw fixation, patient recovered well. Case 5 six nail, male, 39 years old, T12 fracture after trauma, admitted to the hospital, posterior fracture reduction with internal fixation and additional 2 screws fixation of the injured spine, the patient was able to go down early and recovered well after surgery. Case 6, high fall injury resulting in L2 burst fracture with spinal cord cone injury, posterior laminar decompression of the posterior convexity of the vertebral canal bone block repositioning pedicle screw internal fixation + posterior fusion, the patient recovered well after the operation. Case 7 Long stage fixation Male, 55 years old, weight 190 pounds, L1/2 vertebral fracture, posterior repositioning internal fixation Case 8: Female, 45 years old, admitted with post-traumatic lumbar pain with numbness and pain in the left lower extremity, admission examination clearly identified as “lumbar 4 burst fracture with cauda equina injury Frankle grade D”, performed “The patient’s numbness disappeared after the operation, and the intervertebral fusion was good at the posterior review in 3 months after the operation. Case 9: Male, 34 years old, was admitted to the hospital with pain in the thoracic back and bilateral lower extremity paralysis after a heavy object hit him, and the admission examination clearly indicated a T11/T12 fracture dislocation with complete spinal cord injury.