Objective To explore the application value of multi-slice spiral CT (MSCT) scanning and MPR sagittal reconstructed image technique in the imaging diagnosis of thoracolumbar vertebral compression fractures. Methods 96 patients with thoracolumbar vertebral compression fractures in our hospital were selected as the study subjects. All subjects underwent X-ray and MSCT examination. The sensitivity, specificity and accuracy in the diagnosis of thoracolumbar vertebral compression fractures were compared between the two methods. The distribution of vertebral fractures and display rates of different types of thoracolumbar vertebral compression fractures were analyzed, and the MSCT findings of thoracolumbar vertebral compression fractures were observed. Results In 96 cases, there were 114 fractured vertebral bodies, and the range was T12-L5, of which T12-L1 was the most (75.44%). The sensitivity and accuracy of MSCT in the diagnosis of thoracolumbar fractures (75.00%, 73.96%) were significantly higher than those of X-ray (60.00%, 64.58%) (P<0.05) but there was no significant difference in specificity between the two diagnostic methods (P>0.05). The display rate of sagittal position in MPR reconstruction for thoracolumbar vertebral compression fractures (90.91%) was higher than coronal position (69.42%) and transverse section (64.46%) (P<0.05). MPR sagittal reconstructed images showed the overall fractures, and the three-dimensional sense was strong. It could well display spinal deformation and broken bone tablets in vertebral canal. Conclusion MSCT scan and MPR sagittal reconstructed image technique are of important value in diagnosis of thoracolumbar vertebral compression fractures.