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Introduction: Percutaneous minimally invasive spine surgery (MISS) is a treatment option for thoracolumbar fractures and we aim to evaluate its outcomes., Methods: A retrospective matched cohort study of all patients with thoracolumbar fractures treated with MISS or open posterior approach., Results: We included 100 MISS and 155 open patients. After controlling for patient characteristics, our results statistically favor MISS in mean operative time, mean intraoperative blood loss, and number of patients requiring postoperative blood transfusions within 48 h., Conclusions: Advantages of using MISS for treatment of thoracolumbar fractures are decreased operative time, decreased blood loss, and fewer patients requiring transfusions., Competing Interests: Dr. Gelb is a board member and fellowship committee chair for AOSpine NA. He receives payment for lectures and for development of educational presentations from AOSpine NA. He receives royalties from DePuy Synthes Spine and Globus Medical. He has stock in the American Society for Investigative Pathology. Dr. Koh receives payment for consultancy from Biomet. His institution receives RO1 grant money from the National Institutes of Health. Dr. Ludwig is a board member for Globus Medical, the American Board of Orthopaedic Surgery, the American Orthopaedic Association, the Cervical Spine Research Society, and the Society for Minimally Invasive Spine Surgery. He is a paid consultant for DePuy Synthes, K2M, and Globus Medical. He receives payment for lectures and travel accommodations from DePuy Synthes and K2M. He receives payment for patents and royalties from DePuy Synthes and Globus Medical. He has stock in Innovative Surgical Designs and the American Society for Investigative Pathology. He receives research support from AO Spine North America Spine Fellowship support, Pacira Pharmaceutical, and AOA Omega Grant. He is a board member of Maryland Development Corporation. He receives royalties from Thieme, Quality Medical Publishers. He is on the governing board of Journal of Spinal Disorders and Techniques, The Spine Journal, and Contemporary Spine Surgery. The authors have no further potential conflicts of interest to disclose.