Objective To assess the clinical efficacy of minimally invasive internal fixation combined with percutaneous kyphoplasty (PKP) in treatment of thoracolumbar burst fractures in the elderly.  Methods Twenty-one cases of neurologically intact thoracolumbar burst fractures treated by PKP between January 2007 and December 2008 were included in this study. There were 8 males and 13 females at age of 65 -78 years (means, 70.6 years). Mean period from injury to operation was (3.7±1.1) days （range, 3-7 days）. The injured segments included T₁₁ in two cases, T₁₂ in six, L₁ in eight and L₂ in five. Kphosis Cobb’s angle, correction degree of kyphosis angle, correction loss of kyphosis, perioperative indicators, visual analogue scale (VAS) and Oswestry disability index (ODI) were evaluated after operation. Results All the cases were followed up for a period of 26-56 months (mean 34.2 months). Operation averaged 98.7 minutes (range, 80-120 minutes) and showed mean blood loss of 32.8 ml (range, 30-85 ml). Ambulation  started at mean 18.2 hours after operation ( range, 8-19 hours). VAS averaged (0.9±0.6) points at postoperative one week. Postoperative X-ray films revealed mean 10.4°correction of kyphotic Cobb angle, followed by mean 1.8 °of loss in the follow-up longer than 24 months. According to hyperextension and hyperflexion radiographies, there was no abnormal activity of fixed segments, implant loosening and breakage or adjacent vertebral fractures.  Conclusion Minimally invasive internal fixation combined with PKP can relieve pain and restore function in a short time and is thought to be a preferable treatment option for thoracolumbar burst fractures in the elderly.