Objective To investigate the clinical significance of applicating posterior internal fixation for regulating spinal curvature in thoracolumbar compression fractures. Methods Between May 2006 and May 2009, 63 patients with thoracolumbar compression fractures were treated, and the clinical data were retrospectively analyzed. Among them, 33 patients received traditional posterior internal fixation in control group; 30 patients underwent posterior internal fixation with spinal curvature correction under C-arm X-ray device in trial group. There was no significant difference in age, gender, cause of injury, injured segment, grade of fracture, and time from injury to operation between 2 groups (P gt; 0.05). The Cobb angle, height of injured vertebral body, and disc height were measured by X-ray examination; loosening and breakage of internal fixation were observed and compared between 2 groups. The recovery rate was calculated according to pre- and post-operative visual analogue scale (VAS) and Oswestry disability index (ODI) scores for each patient. Results All cases were followed up 20-45 months (mean, 31 months). The postoperative VAS score, ODI, Cobb angle, height of injured vertebral body, and disc height were improved significantly when compared with preoperative values in 2 groups (P lt; 0.05). At last follow-up, VAS and ODI scores of trial group were significantly better than those of control group (P lt; 0.05); loss of Cobb angle was (2.1 ± 1.7)° in trial group and (4.2 ± 3.2)° in control group, showing significant difference (t=1.457, P=0.000); loss of disc height was (1.4 ± 1.2) mm in trial group and (3.4 ± 2.3) mm in control group, showing significant difference (t=9.336, P= 0.000); loss of height of injured vertebral body was 1.8% ± 0.6% in trial group and 5.4% ± 2.1% in control group, showing significant difference (t=3.435, P=0.000). Broken screw and loosening screw occurred in 1 case of control group, respectively (6.1%), but no broken or loosening screw in trial group, showing significant difference (P=0.000). Conclusion Application of posterior internal fixation for regulating spinal curvature has a good clinical effectiveness. The postoperative spinal curvature, the height of injured vertebral body, and disc height can be improved significantly and low back pain can be recovered satisfactorily. The modified technique is also effective in reducing broken and loosening incidence of the fixation system.