Osteoporotic vertebral compression fractures are often multiple, and the purpose of this article is to discuss how to select the fractured vertebrae that cause symptoms (diseased vertebrae) as well as common misconceptions and methods of prevention. [Methods] We retrospectively analyzed 48 patients with osteoporotic compression fractures treated by percutaneous translaminar vertebroplasty of 78 vertebrae, 15 men and 33 women, aged 67-82 years, mean 7713 years, with vertebral fracture sites T8 to L5, who underwent thoracolumbar frontal and lateral radiographs and T1W1, T2W1 and STIR MR I examinations before surgery, and identified the diseased vertebrae by combining the patients’ pain and percussion sites. The clinical efficacy was evaluated by VAS score and Oswestry dysfunction index (OD I) score, and complications were analyzed. [All patients were followed up for more than 1 year, with a mean of 1516 months (12-26 months), and the VAS scores ranged from 911 preoperatively to 212 postoperatively and 215 at the final follow-up (P < 01001). One patient with a T8 vertebral fracture had basic postoperative relief of back pain, but not bilateral rib pain. one patient had nerve injury during intraoperative puncture and had postoperative lower extremity pain, one patient had immediate postoperative symptoms of bone cement monotoxicity, and three patients had a chest radiograph showing pulmonary embolism but had no pain. The chest X-ray showed pulmonary embolism but no clinical symptoms, and 20 cases showed different degrees of bone cement leakage, but no nerve compression symptoms and no serious complications such as death. [The selection of diseased vertebrae in osteoporotic compression fractures should be considered comprehensively, not only based on radiographs, but more importantly, combined with the fact that the diseased vertebrae showed low signal on T1W1 image, high signal on T2W1 image, and still showed high signal on STIR image; puncture is not necessary for old fractures; puncture should reach the heaviest part of the fracture as much as possible, and if necessary, bilateral puncture should be used; to avoid pulmonary embolism, it is necessary to wait until the bone cement is thicker, i.e., doughy. To avoid pulmonary embolism, the bone cement must be injected when it is thicker, i.e., doughy.