BackgroundThis is a retrospective study to evaluate the efficacy of percutaneous short segment fixation (PSSF) with or without intermediate screws in Magerl A3 thoracolumbar (TL) fractures accompanied with low bone mineral density (BMD).Methods From January 2017 to December 2018, 30 patients diagnosed with Magerl A3 TL fractures having a BMD between 0.5/cm2 and 1g/cm2 in the lumbar vertebrae with intact neurological functions and a history of major trauma who underwent PSSF with or without intermediate screws were enrolled in this study. The patients were divided into two groups of those with intermediate screws (group F) or without (group S). The operation time and intra-operation blood loss were recorded. Oswestry disability index (ODI) questionnaire and visual analogue scale (VAS) were employed as clinical assessments and quantified. Radiographic follow-up assessed according to the Cobb angle (CA), Vertebral wedge angle (VWA), and anterior vertebral body height (AVBH).ResultsLoose screws were observed in 4 of the 30 enrolled patients. Significant differences were observed in operation time and intra-operative blood loss between the two groups. The enrolled patients’ clinical results (VAS and ODI scores) were good, however, no significant differences during all follow-up periods were present between the two groups. Radiographic evaluation (CA, VWA and AVBH) improved immediately after surgery, but significant correction loss was observed in the follow-up periods, especially in the first month. Radiographic evaluation demonstrated no significant differences between the two groups.Conclusion Although the patients’ clinical results were satisfactory, PSSF could not resist the correction loss in Magerl A3 TL fractures accompanied with BMD below 1g/cm2. Accordingly, the use of intermediate pedicle screws may be unnecessary due to their limited ability in resisting correction loss and increasing operation time as well as intra-operation blood loss.