OBJECTIVE: Posterior convex plasty for osteoporotic spine fractures has been used as a routine clinical procedure with satisfactory results. Osteoporotic spondylolisthesis fractures are often associated with bone ingress into the spinal canal and/or neurological deficits, and it is not possible to control cement extravasation into the spinal canal and achieve spinal decompression during retroconvective kyphoplasty. Therefore, osteoporotic spondylolisthesis is a contraindication to percutaneous kyphoplasty. Open kyphoplasty combined with posterior spinal canal decompression can achieve solidification of the vertebral body to prevent cement extravasation into the spinal canal at the same time as spinal canal decompression. To evaluate the clinical results of this surgical approach in the treatment of osteoporotic burst fractures in the elderly. To provide a treatment option for elderly patients with osteoporotic burst fractures who are unable to tolerate conventional surgery. METHODS: Patients undergoing retroconvex plasty for osteoporotic compression fractures from September 2005 to December 2008 were retrospectively analyzed. Twelve of these patients with high-grade osteoporotic burst fractures who underwent open retroconvex plasty were analyzed. All patients underwent open kyphoplasty with bilateral laminectomy for canal decompression, with intraoperative repositioning of the bone mass and protection of the dura and nerves. Finally, an open kyphoplasty was performed under direct vision through both arches, and the cement was monitored for entry into the spinal canal and removed in a timely manner. A total of 12 patients with 17 segmental fractures (thoracic 4 to lumbar 4) were treated, and 12 segments (thoracic 7 to lumbar 2) were decompressed. The mean age was 80.4 years for 5 males and 7 females. Postoperative follow-up was recorded for blood loss, operative time, complication occurrence, pain assessment using VAS (Visual Analagial Score) score 0-10, clinical function assessment using ODI (Oswestry Disability Index Oswestry Dysfunction Index) score, measurement of the posterior convexity angle Cobb for their posterior convexity angles were assessed and compared with preoperative and statistically analyzed. RESULTS: The mean postoperative follow-up was 10.5 months (1 to 27 months). The mean surgical blood loss was 238 ml. The mean operative time was 85 minutes per segment. There were significant differences in VAS score, ODI score, and Cobb angle at the mean 7-10 days and at the last follow-up postoperatively compared to the preoperative period. Bone cement extravasation into the spinal canal occurred in 3 cases and was removed intraoperatively. There was one case of postoperative cerebrospinal fluid leak. There were no serious complications such as spinal cord and nerve injury. CONCLUSION: Open kyphoplasty combined with posterior spinal canal decompression for osteoporotic spinal burst fractures has a shorter operative time and is less invasive. Effective decompression can be achieved, and bone cement leakage can be prevented, controlled and treated in a timely manner. Postoperatively, it can rapidly relieve pain, improve function and correct the posterior convexity deformity without serious complications, which is a safe and effective treatment method. It is a safe and effective treatment method for elderly patients with many preoperative coexisting conditions who cannot tolerate traditional incisional internal fixation surgery. However, due to the short observation period, its long-term results remain to be evaluated.