Abstract: Objective To compare effect of open reduction and internal fixation as well as percutaneous balloon dilatation vertebroplasty in the treatment of senile thoracolumbar compression fractures. Methods A total of 152 patients with senile thoracolumbar compression fractures were selected as research objects, and were divided into control group and study group according to random throwing method. The control group performed open reduction and internal fixation, and the study group performed percutaneous balloon dilatation vertebroplasty. The operation time, intraoperative blood loss, and time to first getting out of bed, surgical efficacy, vertebral body height, Cobb angle, Visual Analogue Scale(VAS)score and complications were compared between the two groups. Results The operation time and time to first getting out of bed in the study group were significantly shorter, and the intraoperative blood loss was significantly less than that in the control group(P<0.05); the total effective rate in the study group was 96.05%, which was significantly higher than 84.21% in the control group(P<0.05). At 3 months after treatment, the vertebral body height in the study group was significantly greater, and the Cobb angle was significantly smaller, and the VAS score was significantly lower han than that in the control group(P<0.05); the complication rate of the study group was 10.53%, which was significantly lower than 25.00% of the control group(P<0.05). Conclusion Percutaneous balloon dilatation vertebroplasty is effective in treating senile compression fractures of the thoracolumbar vertebrae and has fewer complications.