Objective  To discuss the curative effect between direct decompression and indirect decompression plus lumbo-iliac fixation for treatment of Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury.   Methods  A retrospective case-control study was performed on clinical data of 47 patients with Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury admitted to Honghui Hospital Affiliated to Xi’an Jiaotong University School of Medicine from March 2012 to March 2017. All patients underwent lumbo-iliac internal fixation. The operation time ranged from 3 to 14 days after injury, with an average of 6 days. In direct decompression group (n=26), the sacral foramina mass was removed during the operation and direct decompression was performed. There were 16 males and 10 females, with age of (36.2±8.4)years. In indirect decompression group (n=21), indirect decompression through traction and distraction was performed. There were 11 males and 10 females, with the age of (38.7±9.8)years. Operation time, intraoperative blood loss, bone union, Mears imaging evaluation, Gibbons score, and Majeed function score were compared between the two groups. Postoperative complications were observed as well.   Results  All patients were followed up for 1233 months,with an average of 16.7 months. The operation time and intraoperative blood loss in direct decompression group were (112.3±26.3)minutes and (512.1±29.4)ml, which had no significant differences in comparison with that in indirect decompression group ［(129.3±25.1)minutes and (529.7±22.1)ml］ (P>0.05). Bone union was observed in all patients. According to the Mears imaging evaluation, the direct decompression group had anatomical reduction in 17 patients, and  satisfactory reduction in 9, and the indirect decompression group had anatomical reduction in 15 patients and satisfactory reduction in 6 (P>0.05). At the last follow-up, Gibbons score in direct decompression group was lower than that in the indirect decompression group ［(1.2±0.3)points vs. (2.2±0.5)points］ (P＜0.01); Majeed function score in direct decompression group was higher than that in indirect decompression group ［(87.3±11.4)points vs. (68.5±16.7)points］ (P＜0.01). In direct decompression group, 1 patient had deep wound infection, while in indirect decompression group, 1 patient had pressure sore due to the protrusion of the tail of the iliac screws on the skin.   Conclusion  For Denis type II sacrum fracture combined with sacral foraminal bone space-occupying lesion and sacral nerve injury, direct decompression with lumbo-iliac fixation can obtain better neural functional recovery and functional recovery of life compared with the indirect decompression.