Background To investigate the clinical effect of percutaneous pedicle screw fixation (PPSF) combined with percutaneous vertebroplasty (PVP) in the treatment of osteoporotic compression vertebral fracture (OVCF) of the thoracolumbar vertebra with kyphosis. Methods One hundred sixty-six patients before June 2017 were retrospectively analyzed, and patients were divided into PPSF + PVP group A and PVP group B. Operative time, bone mineral density, postoperative bed time, high compression ratio, bone cement leakage rate, and bone cement dose were recorded. Comparison of vertebral anterior edge height, Cobb angle, visual analogue score (VAS), and low back pain dysfunction index (ODI) between the two groups in preoperative, postoperative 3 days, postoperative 6 months, postoperative 12 months, and postoperative 24 months, postoperative complications were observed in the two groups. Results The operation time of group A was longer than that of group B (59.0 +/- 8.6 min, 26.6 +/- 5.2 min), longer postoperative bed rest time (3.3 +/- 0.7 days, 1.2 +/- 0.5 days), the differences were statistically significant (P < 0.01), there was no difference in the amount of bone cement between the two groups (5.4 +/- 0.6 ml, 5.3 +/- 0.8 ml) (P > 0.05). The height of the anterior edge and Cobb angle of the two groups recovered significantly in postoperative 3 days. The height of anterior edge (2.7 +/- 0.3 cm, 2.6 +/- 0.2 cm, 2.5 +/- 0.7 cm; 2.3 +/- 0.6 cm, 1.7 +/- 0.5 cm, 1.6 +/- 0.3 cm) and Cobb angle (4.9 +/- 2.2, 5.5 +/- 2.3, 5.7 +/- 2.3; 12.4 +/- 3.2, 17.2 +/- 2.5, 13.2 +/- 2.3) was statistically significant in postoperative 6 months, postoperative 12 months, and postoperative 24 months (P < 0.01). VAS and ODI scores of postoperative 6 months and 12 months were significantly different between the two groups (P < 0.05). Postoperative complications in group B were much higher than those in group A. Conclusion The efficacy of PVP alone was not satisfactory, and the rate of complications was high for OVCF patients with severe anterior edge compression with kyphosis. PPSF combined with PVP is recommended, the vertebral height loss was not obvious, the satisfaction was good, and the complication rate was lower during 2 years follow-up.