Purpose To study the clinical outcome of percutaneous balloon kyphoplasty through the inferior pedicle approach for the treatment of severe osteoporotic vertebral body compression fractures (OVCF). Method A retrospective study of 48 patients with severe osteoporotic vertebral compression fractures (vertebral compression degree> 67%) from January to December 2020 were enrolled. A modified low-position parallel puncture method was used to treat the kyphoplasty through bilateral inferior pedicle approach. Clinical outcome was evaluated by the patient's pain, the functional score of the low back; imaging measurement of vertebral body height and angle reduction before and after surgery; and postoperative complications and treatment. Result All 48 patients underwent general anesthesia with kyphoplasty. A total of 63 vertebral bodies were treated. The average single vertebral body operation time was 39±10 minutes, After PKP procedure, the anterior edge height of the vertebral body recovered 3.2±2.5mm, the height of the middle part of the vertebral body recovered 3.0±2.1mm, the Cobb angle recovered 2.8±2.1°, the VAS pain degree improved 4.9±1.0, the difference was statistically significant before and after surgery (P<0.05). There were no complications such as nerve damage, cerebrospinal fluid leakage or bleeding caused by puncture, and asymptomatic bone cement leakage occurred in 7 patients. Conclusion Kyphoplasty via the inferior edge of the pedicle can safely and conveniently establish a working channel for bone cement augmentation with conventional fluoroscopy and puncture tools. It has excellent clinical efficacy in treating severe osteoporotic vertebral compression fractures. Key words kyphoplasty, spinal fracture, osteoporosis