Abstract: Objective To investigate the clinical effectiveness of unilateral transverse process-pedicular percutaneous vertebroplasty (UTPP-PVP) in the treatment of thoracolumbar osteoporotic vertebral compression fracture (OVCF) in the elderly. 
 Methods The clinical data of 156 elderly patients with thoracolumbar OVCF who were hospitalized in the Department of Orthopedics of Handan Central Hospital from October 2019 to October 2022 were collected. Based on different surgical approaches, the patients were divided into UTPP group and unilateral transpedicular (UTP) group, and the duration of operation, bone cement injection volume, excellent rate of bone cement distribution and bone cement leakage rate were compared between the two groups. The visual analogue scale (VAS) scores and Oswestry disability index (ODI) scores were compared between the two groups before surgery, at 1 d, 1 month and 1 year after surgery. The anterior vertebral body height and the Cobb angle were compared between the two groups before surgery, and at 1 d and 1 year after surgery. 
 Results There was no significant difference in duration of operation between the UTPP group and the UTPP group ［(48.38±3.55) min vs. (48.59±3.50) min, P＞0.05］, the cement injection volume was greater than that of the UTP group ［(5.03±0.63) mL vs. (4.11±0.51) mL］, the excellent distribution rate of bone cement was higher than that of the UTP-PVP group (92.96% vs. 61.18%), and the leakage rate of bone cement was significantly lower than that of the UTP group (7.04% vs. 18.82%,P＜0.05). Over time, both VAS scores and ODI scores showed a decreasing trend, with significant differences in the interaction between time points and time points between groups (P＜0.001), but no significant differences between groups (P＞0.05). At 1 d and 1 year after surgery, the anterior vertebral body height of both groups was higher than that before surgery, and the Cobb angle was lower than that before surgery, with significant differences in interaction between time points (P＜0.001). However, there was no significant difference in the interaction between groups and time points between groups (P＞0.05). 
 Conclusion UTPP-PVP can ensure unilateral diffusion and bilateral diffusion as well as uniform distribution of bone cement, and early off-bed activity can be achieved with reduced thoracolumbar pain and good functional recovery after surgery. 

Key words: spinal fractures, osteoporosis, vertebroplasty, transverse process-pedicular approach