Abstract [Objective] To compare the clinical efficacy of modified unilateral puncture vertebroplasty and bilateral pedicle vertebroplasty (PVP) in the treatment of lumbar osteoporotic compression fracture OVCF).[Methods]The clinical data of patients who underwent PVP surgery for lumbar OVCF in the author's Hospital from June 2020 to December 2020 were analyzed retrospectively. According to different surgical methods, they were divided into group A (51 cases, unilateral puncture PVP through the posterior upper edge of the vertebral body) and group B (35 cases, bilateral pedicle PVP).The operation time, intraoperative fluoroscopy times, bone cement injection volume, hospitalization expenses, bone cement distribution and leakage of the two groups were recorded and compared, and the preoperative and postoperative visual analog scale / score vas and dysfunction index (ODI) scores were compared. The long-term complications, including re fracture of injured vertebra and adjacent vertebral fractures, were observed during follow-up. [Results] There was no significant difference in gender, age, operative segment, t value of bone mineral density, oltics score, preoperative vas and ODI score between the two groups (P > 0.05); The times of fluoroscopy and hospitalization expenses in group A were significantly less than those in group B (P < 0.05), but the operation time was longer than that in group B (P < 0.05); There were no complications such as nerve and vascular injury caused by puncture and neurological symptoms caused by bone cement leakage in both groups; There was no significant difference between the two groups in the amount of bone cement injection, the excellent rate of bone cement distribution, the incidence of leakage, adjacent vertebral fracture and re fracture of injured vertebral body (P > 0.05). In addition, there were significant differences in postoperative vas and ODI scores between the two groups compared with those before operation (P < 0.05), but there was no significant difference between the two groups at each follow-up time point (P > 0.05). At the last follow-up, the excellent and good rates of improved macnab standard in group A and group B were 94.12% and 91.43% respectively (P > 0.05).[Conclusion] Compared with surgery of vertebroplasty by bilateral pedicle approach , unilateral puncture PVP through the posterior upper edge of the vertebral body can also obtain satisfactory curative effect in the treatment of osteoporotic lumbar compression fractures, and has the advantages of optimizing the operation process and saving cost, but it has a certain learning curve.