Abstract: [Objective] To observe the efficacy of posterior approach augmented pedicle screw instrumentation combined with percutaneous kyphoplasty (PKP) in treatment elderly patients with severe osteoporotic vertebral compression fractures (OVCF). [Method] A retrospective study was made on 72 elderly patients with severe OVCF who underwent posterior approach augmented pedicle screw instrumentation combined with PKP, the pain visual analog scale (VAS) scores, Oswestry dysfunction index (ODI) were evaluated before surgery and 1 week, 1 year, 2 years after the surgery, and at the last follow-up, the local kyphotic Cobb angle, the height of the anterior edge of the injured vertebra, and the sagittal index (SI) was measured; the complications during follow-up were counted. [Results] The follow-up time was 24 to 66 months, with an average of (36.21±6.94) months. There were 2 cases of bone cement leakage,9 cases (12.50%) of new fractures. At 1 week, 1 year, 2 years, and the last follow-up, the VAS score, ODI, and Cobb angle were significantly lower than before surgery (P<0.05), the anterior edge height ratio and SI were significantly higher than those before surgery (P<0.05); compared with 1 week after surgery, the loss rates of Cobb angle, anterior edge height ratio and SI at the last follow-up were 13.35%, 4.79%, 2.97%,respectively. [Conclusion] The posterior approach augmented pedicle screw instrumentation combined with PKP is safe and effective for the treatment of severe OVCF in the elderly. It can effectively reconstruct the height of the injured vertebrae and correct the kyphotic deformity, and the medium and long-term maintenance effect is satisfactory.