Objective To study the effects of modified extrapleural approach and bone grafting combined with anterolateral decompression fixation in the treatment of thoracolumbar fractures and spinal cord injuries and to analyze the application of CT imaging technique in perioperative period. Methods 46 patients with thoracolumbar fractures and spinal cord injuries treated in our hospital from 2009 to 2015 were selected as the research objects. These patients were treated with modified extrapleural approach and bone grafting combined with anterolateral decompression fixation. Multislice CT three dimensional reconstruction and routine X-ray examination were performed before and after operation. Results All the 46 cases were followed up for 12 months in average (6-24 months). Except for 1 patient with intraoperative pleural injury, there were no angiomegaly of injured waist, injured organs, injured spinal cord, postoperative internal fixation loosening and other complications. Frankel grading method showed obvious improvement of nerve function. After postoperative CT reconstruction scanning, 46 patients showed good effects of fracture reduction and there was no oppression in the spinal canal. Conclusion Anterolateral decompression fixation in the treatment of thoracolumbar fractures and spinal cord injuries is direct and complete. The application of CT reconstruction technique in thoracolumbar fractures and spinal cord injuries can achieve accurate diagnosis and treatment evaluation of the disease.