Background <p>Studies have shown that there are significant individual differences in the prognosis of osteoporotic vertebral compression fractures. The underlying mechanisms are closely related to the choice of surgical method, the distribution of bone cement within the vertebral body, and the degree of recovery of the injured vertebral height. Although some scholars have explored this issue, there is still a distinct lack of evidence from systematic comparative studies. How to achieve optimal cement distribution and individualized and precise treatment remains a key concern for spine surgeons.</p> Methods <p>A retrospective cohort study was conducted to include 106 patients with single-segment osteoporotic vertebral compression fractures admitted to the Fifth Affiliated Hospital of Xinjiang Medical University from May 2019 to February 2025, and they were divided into percutaneous vertebroplasty group (n=55) and percutaneous vertebral kyphoplasty group (n=51) according to surgical methods. The postoperative VAS scores, Oswestry dysfunction index, localized posterior convexity angle of the injured vertebrae, cement dispersion height and its percentage, and the incidence of postoperative complications at 6-month follow-up were compared between the two groups, to investigate the influence of cement dispersion height on surgical outcomes based on the quantitative analysis of imaging between PVP and PKP.</p> Results <p>There was no statistically significant difference in the general data of the two groups (<i>p</i>&gt;0.05); the two groups showed significant differences in perioperative surgery-related indexes (<i>p</i>&lt;0.05).VAS score, Oswestry dysfunction index, and localized posterior convexity angle of the injured vertebrae were lower than that of the preoperative period on the first day after surgery and at 6 months after surgery in both groups (p all &lt;0.05); the differences in Oswestry dysfunction index and localized posterior convexity angle of the injured vertebrae were significant in the comparison of the two groups (p all &lt;0.05); ODI index and localized posterior convexity angle of the injured vertebrae were significantly different in the PKP group as compared with the PVP group at 6 months after surgery (p all &gt;0.05); and ODI index and localized posterior convexity angle of the injured vertebrae were significantly different in the two groups. The difference between the PKP group and the PVP group was statistically significant (<i>p</i>&lt;0.05); the difference between the PKP group and the PVP group was statistically significant (p&lt;0.05); the difference between the PKP group and the PVP group in the ODI index at 6 months postoperatively was statistically significant (<i>p</i>&gt;0.05).The differences in the heights of the anterior vertebral column, middle column and vertebral body, and their cement dispersion heights and the percentage of dispersion heights between the two groups were statistically significant (p all &lt;0.05); the heights of the anterior vertebral column, middle column and vertebral body, and their cement dispersion heights and percentage of dispersion heights of the PKP group were significantly superior to those of the PVP group after surgery (p all &lt;0.05).The differences in the rates of cement leakage and adjacent vertebral fracture between the two groups were significant (p all &lt;0.05); the rates of cement leakage and the risk of secondary fracture of vertebral body of neighboring segments between the two groups were significantly different, and the PKP group was better. (<i>p</i>&lt;0.05).</p> Conclusions <p>Both PVP and PKP can significantly improve pain and other symptoms and improve the prognosis of patients with osteoporotic vertebral compression fracture.The PVP procedure has significant advantages in terms of operation time, frequency of intraoperative imaging monitoring, and volume of cement infusion. However, the PKP group was superior in terms of postoperative vertebral body height recovery, control of cement leakage, improvement of visual analog score (VAS) for pain, and recovery of Oswestry dysfunction index (ODI). The latest study further found that the three-dimensional dispersion height of the cement in the vertebral body and its percentage of the vertebral body volume can be used as a potential imaging predictor to evaluate the efficacy of the two surgical procedures, which provides a new reference dimension for the selection of the clinical surgical procedures and prognosis assessment.</p>