Objective:To compare the efficacy and safety of different approaches of percutaneous vertebroplasty(PVP)in the treatment of osteoporotic vertebral compression fractures(OVCFs).Methods:A total of 180 patients with OVCFs treated by PVP were collected and divided into two groups according to different surgical approaches.Among them,88 patients under-went unilateral pedicle approach PVP as unilateral approach group,and 92 patients underwent bilateral pedicle approach PVP as bilateral approach group.The visual analogue scale(VAS)pain score and Oswestry disability index(ODI)were evaluated be-fore operation,1 month and 12 months after operation,and the anterior vertebral height and kyphosis Cobb angle were meas-ured.The operation related indexes and complications of the two groups were compared.Results:Compared with the bilateral approach group,the unilateral approach group had shorter operation time(P<0.05),less intraoperative blood loss and fluoros-copy times(P<0.05),and lower bone cement volume(P<0.05).The VAS score and ODI index of the two groups at 1 month and 12 months after operation were lower than those before operation(P<0.05).The height of the anterior edge of the injured vertebra and the Cobb angle of the kyphosis were improved compared with those before operation(P<0.05).There was no significant difference in VAS score,ODI index and above imaging parameters between the two groups before and after operation(P>0.05).The incidence of bone cement leakage in the unilateral approach group was 13.64%,and the incidence of bone cement leakage in the bilateral approach group was 17.39%,there was no significant difference between the two groups(P>0.05).Conclusion:Unilateral pedicle approach PVP can achieve similar efficacy as bilateral pedicle approach PVP.Com-pared with bilateral approach surgery,unilateral approach surgery has the advantages of shorter operation time and less radia-tion damage.