[Objective] To compare the difference of polymethylmethacrylate (PMMA) leakage after percutaneous kyphoplasty (PKP) treatment for osteoporotic vertebral compression fractures (OVCFs) with and without intravertebral vacuum cleft (IVC). [Methods] In total, 142 patients treated for single-OVCFs, which was 52 patients in IVC group, 90 patients in non-IVC group, were retrospectively reviewed. The follow-up period was at least 2 years. Plain X-rays and CT would be performed postoperatively to investigate PMMA distribution pattern within the affected vertebrae, the presence of PMMA leakage and leakage types. Furthermore, we would compare the difference between two groups. [Results] There were no significant changes in operation time, bone cement injection amount, injection time, early downfield time and hospitalization time between the two groups The local solid lump distribution pattern accounted for 65.4% in IVC group and 81.1% in non-IVC group. The PMMA leakage occurred in 9 (17.3%) of 52 patients in IVC group and in 15 (16.7%) of 90 patients in non-IVC group, without significant difference (P>0.05). The leakage types that frequently occurred were intradiscal (6/9, 66.7%) in IVC group and perivertebral venous (11/15, 73.3%) in non-IVC group. A significant difference was found between both groups. Postoperative VAS score, ODI showed statistically significant differences than preoperative.(P<0.05). In terms of complications, , there were 3 cases of re-fracture and 5 cases of poor postoperative pain relief in IVC group; there were 2 cases of re-fracture and 4 cases of poor postoperative pain relief in non-IVC group; there were no nerve injury and other complications occurred in both groups. [Conclusion] The incidences of PMMA leakage in osteoporotic compression fractures with and without IVCs were similar; however, leakage type frequencies differed of PMMA leakage in osteoporotic compression fractures with and without IVCs were similar; however, leakage type frequencies differed