Abstract: [Objective] To compare the clinical efficacy of bilateral pedicle puncture kyphoplasty and unilateral pedicle puncture kyphoplasty (PKP) in the treatment of thoracolumbar compression fractures caused by spinal metastases. [Method] Retrospective analysis was performed on the clinical data of 51 patients with spinal metastasis complicated with pathological fracture admitted to our hospital from April 2019 to April 2020. According to surgical methods, they were divided into two groups: unilateral group, 28 patients were treated with kyphoplasty via unilateral pedicle; In bilateral group, 23 patients were treated with kyphoplasty via bilateral pedicle. Perioperative, follow-up and imaging data were compared between the two groups. [Result] VAS score, ODI and KPS score at each time point after surgery were significantly better than those before surgery (P < 0.05), but there was no statistical significance between the two groups at each time point (P > 0.05).There were no significant differences in operation time and bone cement injection amount between 2 groups (P > 0.05).The height of the anterior edge of the injured vertebra and the Cobb Angle of the local kyphosis in the two groups were significantly improved after surgery compared with that before surgery (P < 0.05), but there was no statistically significant difference in the imaging indicators between the two groups at corresponding time points (P>0.05).The bone cement leakage rate of unilateral group was significantly different from that of bilateral group (P < 0.05). [Conclusion] Percutaneous kyphoplasty can effectively improve the quality of life of patients with vertebral metastasis. Bilateral pedicle puncture can improve the diffusion of bone cement in the affected vertebrae while reducing the risk of intraoperative bone cement leakage.