Objective To observe the outcomes of one-stage posterior short-level pedicle screw fixation combined with anterior fixation of severe thoracolumbar fractures. Methods A retrospective case series study was performed on 21 patients with severe thoracolumbar fractures stabilized by posterior short-level pedicle fixation combined with anterior internal fixation at one stage from January 2012 to December 2014. There were 16 males and 5 females, at age of 17 and 64 years [(38.7±11.4)years]. The involved segments included T11 in 2 patients, T12 in 5, L1 in 6 and L2 in 8. For AO fracture classification, type A fractures were seen in 4 patients, type B in 7 and type C in 10. Thoracolumbar injury classification and severity score (TLICS) was (8.12±0.87)points (range, 7-10 points). Frankel neurological performance scale was Grade B in 8 patients, Grade C in 11 and Grade D in 2. Operation time, blood loss, nerve function, kyphosis correction and complications were reported. Results Operation time was (234.5±57.3)min (range, 180-360 min), and blood loss was (387.4±124.4)ml (range, 260-950 ml). Time of follow-up was (19.8±3.5)months (range, 14-25 months). Nerve function of 18 patients was improved by at least one Frankel scale. Cobb angle was (4.1±5.3)° at postoperative 3 days and (4.0±4.9)°at the final follow-up, showing significant differences from that before operation [(-9.3±4.2)°] (P<0.05). While the difference of Cobb angle did not differ significantly at postoperative 3 days and at final follow-up. No cerebrospinal fluid leakage, vascular injury, incision infection or nerve function deterioration occurred. Conclusion One-stage posterior short-level pedicle screw fixation combined with anterior decompression and bone graft fixation is characterized by short operation time, few blood loss, good correction of traumatic kyphosis and good neurological recovery, indicating a good surgical choice for severe thoracolumbar fractures. Key words: Thoracic vertebrae; Lumbar vertebrae; Fracture fixation, internal