Abstract: [Objective] To analyze and compare the clinical efficacy of PVP, PKP and PSO in the treatment of thoracolumbar osteoporotic fracture with kyphosis. [Methods] From May 2016 to December 2018, 105 patients with thoracolumbar osteoporotic fracture with kyphosis and PVP, PKP or PSO were divided into 3 groups. The Cobb''s angle, ODI index and VAS score were evaluated before and 1 month, 6 months and the last follow-up after operation, and the operation time, intraoperative blood loss, hospital stay and postoperative complications were recorded, and the statistical differences before and after operation and between groups were analyzed and compared. [Results] PSO group had the longest operation time and hospital stay, and the most blood loss during operation (P<0. 05). Cobb''s ''s angle, ODI index and VAS score were significantly improved at each time point in the three groups after operation (P<0. 05). The Cobb''s angle of PSO group was lower than that of the other two groups at each time point, and the Cobb''s angle of PKP group was lower than that of PVP group (P<0. 05). The ODI index of PSO group was the lowest at all time points after operation, and there was significant difference at the last follow-up (P<0. 05). The ODI index of PKP group was lower than that of PVP group at 6 months after operation and at the last follow-up (P<0. 05). The leakage rate of bone cement and the rate of recurrent bone fracture in PKP group were lower than those in PVP group (P<0. 05). [Conclusion] The clinical efficacy of PSO is the best, and the clinical efficacy of PKP is better than that of PVP. For patients with severe kyphosis whose physical conditions permit, priority can be given to PSO. For patients with poor general conditions who need to choose minimally invasive surgery, PKP can be chosen.