Objective To analyze the advantages and disadvantages of multi-slice spiral CT (MSCT), magnetic resonance imaging (MRI) and the combination of the two in the diagnosis of lumbar vertebral compression fractures. Methods Ninety-three patients with lumbar vertebral compression fractures treated in our hospital between February 2014 and February 2016 were studied. MSCT, MRI and combined diagnosis were performed in the patients. The range and distribution of fractures were analyzed. MSCT and MRI findings of lumbar vertebral compression fractures were also analyzed. The detection rates were compared betweeb MSCT, MRI and the combination of the two in the diagnosis of lumbar vertebral compression fractures. Results The MSCT diagnosis found that there were significant differences in clear and sharp fracture line, spinal cord contusion and hemorrhage, paravertebral soft tissue shadow, appendix fractures, contusion of vertebral body surrounding organs, intervertebral disc vacuum signs, disorder and sclerosis of vertebral trabecular bone structures between fresh vertebral compression fractures and oboslete lumbar vertebral compression fractures (P<0.05). The detection rates of MRI and MSCT combined with MRI in lumbar vertebral compression fractures were higher than that of MSCT (P<0.05). Conclusion MSCT plays an important role in the diagnosis of lumbar vertebral compression fractures. MRI can reflect the spinal cord and ligament injury. The combined diagnosis of MSCT and MRI can improve the accuracy of diagnosis.