Objective: To study the clinical effect of unilateral percutaneous vertebra plasty (PVP) in the treatment of osteoporotic lumbar compression fracture (OVCF) in the elderly. Methods: 84 elderly patients with OVCF who were treated in our hospital from January 2017 to December 2020 were included and divided into unilateral group (n=42) and bilateral group (n=42) according to the random number table method. Unilateral PVP treatment was performed in the unilateral group, and bilateral PVP treatment was performed in the bilateral group. Observed two groups of X-ray machine, bone cement dosage irradiation time and operation time indicators such as surgery, preoperative and postoperative and postoperative convex Cobb Angle, after 1 years of vertebral body lesions vertebral body height and body function, preoperative and postoperative 7d and postoperative pain degree and 1 year serum Norepinephrine (NE) and Serotonin (5-HT) and Substance P (SP) and so on pain factor levels, postoperative complications and other indicators; Results: the time of X-ray machine irradiation, amount of bone cement and operation time in theunilateral group were all lower than those in the bilateral group (P<0.05). After surgery and 1 year after surgery, there was no difference in Cobb Angle of kyphotic vertebra, height of diseased vertebra and limb function between the two groups (P>0.05).There was no difference in VAS scores and 5-ht, SP and NE levels between the two groups after and 1 year after surgery(P>0.05).The incidence of postoperative complications in the unilateral group (19.05%) was lower than that in the bilateral group (47.62%) (P<0.05). Conclusion: unilateral PVP can achieve the same effect as bilateral PVP in the treatment of elderly OVCF. Small trauma, easy to operate, can effectively relieve patients' pain, safe and reliable, worthy of clinical recommendation.