Objective To investigate the difference and application value of X ray and CT scan in the diagnosis of thoracolumbar spinal fracture. Methods 82 cases of thoracolumbar spinal fracture patients in our hospital were selected from January 2013 to January 2015. X line and CT scan were performed in all patients after admission. The results were confirmed by surgery, compared the diagnostic accuracy of the two methods in the diagnosis of thoracolumbar spinal fracture and the diagnostic accuracy. Results After surgery and pathology confirmed that 82 cases of patients with a total of 103 vertebral fractures, including a single vertebral fracture in 61 cases, multiple vertebral fractures in 21 cases, the main injury site was T12-L2. The results were confirmed by surgery. The comprehensive compliance rate of X-ray examination for thoracolumbar spinal fracture classification was 54.9%, while the CT scan examination was 82.9%. The difference was statistically significant (P<0.05). There are some differences in the characteristics of X-ray and CT scan in the 3 types of fracture. The diagnostic accuracy of X-ray film was 53.7%, while the CT scan examination was 87.8%.There was statistical significance in the difference of diagnostic accuracy (P<0.05). Conclusion In the process of clinical diagnosis of thoracolumbar spinal fracture, compared with X-ray examination and diagnosis, CT scan is more accurate and reliable, it has a better application prospect, and it is worthy of further popularization and application.