Purpose: Spinal compression fractures of the thoracolumbar spine caused by osteoporosis have become a common cause of disease and death in the elderly, and performing minimally invasive PVP&PKP surgery to treat osteoporotic compression fractures is recognized by the majority of clinicians. However, the operation time of bilateral puncture minimally invasive surgery is long, the operation risk is increased, the spinal nerve is easily damaged, and the operation cost is high, which increases the economic burden of patients. To explore the surgical technique, clinical efficacy of unilateral extra-arch root approach to puncture PVP}PKP, and to provide some reference basis for minimally invasive operation in spinal surgery. METHODS: By counting patients who were hospitalized and treated with PVP}PKP in the orthopedic spine ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from November 2009 to 07, 2012. 526 patients who could be followed up regularly were selected, including 120 cases of bilateral puncture and 406 cases of unilateral puncture. Early functional exercises were actively performed after surgery, and data related to JOA lower back pain score, VAS pain score, compression rate of diseased vertebrae, and sagittal Cobb angle change were collected from patients before and after surgery, and using relevant software, retrospective analysis was performed, and how effective the treatment of osteoporotic vertebral compression fractures with unilateral extra-arch root access puncture PVP}PKP was observed. Results: Postoperative follow-up was performed for each patient, and the follow-up period ranged from 6 months to 20 months, with an average of 11 months. 526 patients had different degrees of improvement and relief of JOA score, VAS pain score, anterior vertebral body edge compression rate, and sagittal Cobb angle, and the improvement rate of JOA score ranged from 34% to 70%; the relief rate of VAS pain score ranged from 55% to 87%; the anterior vertebral body edge The average compression rate decreased from 68.19% before surgery to 18.2% after surgery; the improvement rate of the sagittal Cobb angle in the thoracolumbar spine was about 62%. The JOA score, VAS pain score, and anterior vertebral compression rate before and after surgery were statistically significantly different. CONCLUSION: PVP}PKP surgery under local anesthesia is relatively simple, with less surgical risk, and can provide good pain relief and improve the compression rate of the fractured vertebral body and spinal function. With the unilateral extra-arch root approach, the puncture needle can reach a sufficient tilt angle to ensure good filling of the entire vertebral body with bone cement, and at the same time reduce the possibility of damaging the spinal nerve and reduce the economic burden of the patient. Unilateral extra-arch root puncture with PVP}PKP is an effective method for treating osteoporotic vertebral compression fractures. Unilateral extraarchal approach; retrobulbar kyphoplasty; percutaneous vertebroplasty; osteoporotic vertebral compression fracture.