On the basis of Denis classification, burst fractures refer to spinal injuries affecting 2 or 3 columns of the spine.1 Thoracolumbar burst fracture account for over half of thoracolumbar traumas and account for 10% to 20% of all kinds of spinal fractures.2 The predominant characteristics associated with thoracolumbar burst fracture include neurologic impairment, kyphosis, and vertebral body height loss. The golden standard for thoracolumbar burst fracture was still in debate.3, 4, 5 Nonoperative therapy has been demonstrated to have good outcomes in treating thoracolumbar burst fracture without neurologic impairment.6,7 Nonetheless, vertebral body height loss and kyphosis were persistent. The surgical procedure was performed to reconstruct the stability and alignment and obtain spinal canal decompression, which allowed early rehabilitation and avoided bed-related complications.8 Posterior pedicle screw fixation has been reported to have great clinical and radiologic results.9, 10, 11, 12 In posterior approach surgery, the spinal canal decompression could be done in a direct and indirect manner. Direct decompression was performed by removing the lamina of the vertebrae to directly expand the spinal canal volume.13 Indirect decompression was achieved through distraction of middle column of thoracolumbar spine and ligamentotaxis.14, 15, 16, 17 This article aimed to perform a meta-analysis summarizing the results of relevant studies to compare the safety and efficacy between posterior pedicle screw fixation with direct decompression and indirect decompression in treating thoracolumbar burst fracture.