Background: Minimally invasive spine surgery has revolutionized the management of thoracolumbar disorders by reducing operative trauma and promoting faster recovery. Objective: This study aimed to evaluate the clinical and radiological outcomes of percutaneous pedicle screw (PPS) fixation, with or without vertebroplasty or kyphoplasty, in patients with lumbar and thoracolumbar vertebral pathology. Patients and Methods: This prospective study included 20 patients treated under fluoroscopy guidance in the last 2 years (2023-2024) at Neurosurgery department, Zagazig university Hospitals and Orthopaedic surgery department, Alahrar teaching hospital, Zagazig, Egypt. Initial care involved a multidisciplinary trauma team that stabilized vital functions and performed diagnostic imaging. Preoperative preparation included thorough patient selection based on specific inclusion and exclusion criteria. The Sextant system was utilized for screw fixation. Patients received general anesthesia and were positioned prone. A minimally invasive approach involved a small incision to access the pedicle, with careful fluoroscopic guidance for screw placement. Results: The cohort had a mean age of 28.65 ± 8.29 years, with traumatic fractures being the most common pathology. VAS scores improved significantly from 7.45 ± 1.05 preoperatively to 1.65 ± 0.88 after one year (p < 0.001). Radiological assessments showed significant differences in vertebral body angle, local kyphosis angle, and wedge index, indicating improved alignment and stability. Conclusion: The PPS technique, combined with anterior column reconstruction, demonstrated promising outcomes in pain relief and spinal stability, suggesting it as a safe and effective substitute to traditional surgical methods for thoracolumbar vertebral diseases. Further studies with larger cohorts are warranted to confirm these findings.