Objective To compare the efficacy of percutaneous minimally invasive surgery and conventional open pedicle screw fixation for treatment of compression fracture of thoracolumbar spine in the elderly. Methods A total of 245 patients with compression fracture of thoracolumbar spine were enrolled in this study, who received the surgery in the Hainan Branch of Chinese PLA General Hospital from June 2013 to February 2017. They were divided into percutaneous minimally invasive surgery (PMIS) group (n=126) and open surgery (OS) group (n=119). The two groups were compared in the perioperative parameters, such as operation duration, length of hospital stay, hospitalization cost, intraoperative bleeding and incision length. The patients were followed up for at least 6 months and the anterior height of injured vertebral body, Cobb angle and sagittal index were measured. Data were analyzed using SPSS statistics 18.0. Depending on the data type, t-test or χ² test were used for comparison. Results Compared with OS group, PMIS group had significantly decreased operation duration[(95.2±16.3) vs(126.5±39.0)min], length of hospital stay[(10.8±4.0) vs(22.5±13.6)d], intraoperative bleeding[(82.7±39.9) vs(327.2±143.1)ml], postoperative drainage [(33.5±15.8) vs (301.5±110.8) ml], hospitalization cost [(5.1±0.3) vs(5.7±0.2)×10⁴ RMB yuan], and incision length [(9.3±0.6) vs(12.8±1.9)cm]. The differences were statistically significant (P<0.05 for all). Postoperative parameters were significantly improvedin both groups:anterior height of injured vertebrae [PMIS group:(11.2±7.3) vs(20.1±3.3) mm; OS group:(12.2±7.6) vs(21.7±2.4)mm], Cobb angle [PMIS group:(14.0±6.8)° vs(4.3±1.8)°; OS group:(14.8±7.0)° vs(4.6±2.8)°], and sagittal index [PMIS group:(64.5±12.6)% vs(93.8±13.9)%; OS group:(63.8±13.8)% vs(95.0±9.6)%] (P<0.05 for all). Conclusion Percutaneous minimally invasive surgery has better efficacy for treatment of compression fracture of thoracolumbar spine in the elderly than conventional open pedicle screw fixation with decreased operation duration, length of hospital stay, intraoperative bleeding, incision length and hospitalization cost. The procedure is therefore worthy of clinical promotion.