Aim:The aim of this randomized controlled trial was to compare the clinical and functional outcomes between combined anterior and posterior 2-segment spinal fusion and posterior 3-segment spinal fusion in patients with thoracolumbar (TL) burst fractures without neurological deficit.Material and Methods:Twenty-seven patients with TL burst fracture, >20° kyphosis/50% collapse, and posterior ligament injury, but without neurological deficit, were randomly assigned into posterior and combined groups. At the final follow-up, the clinical and functional means of the groups were compared. Results:Fourteen and 13 patients were treated with the combined and posterior approach, respectively. Age (40.0±10.3 and 37.0±14.2 years; P=.519), sex (female/male, 3:10 and 5:9; P=.385), mechanism of injury (P=.513), fractured levels (P=.185), type of fracture (P=.293), degree of kyphosis at initial admission (P=.616), collapse (P=.155), canal narrowing (P=.280), follow-up (P=.076) and accompanied limb fracture (P=.374) were similar between groups. Duration of hospital stay was similar between groups (P=.102). However, blood loss was was higher in combined group (195ml versus 358ml, P=0.003). A 14.2° correction was achieved in the posterior group and 16.9° in the combined group (P=.61). Loss of correction at the last follow-up visit was 2.1° with a final kyphosis of 7.2° in the posterior group and 1.2° with a final kyphosis of 5.5° in the combined group. The differences in the correction of kyphosis (P=.616), postop kyphosis (P=.756), loss of correction (P=.141) and final kyphosis (P=.085) between the treatment groups were not significant. At the last follow-up visit scores were similar.Conclusion:Both treatment methods are similar in terms of clinical and functional outcomes.