Abstract:[Objective] To compare the clinical outcomes of unilateral cyst-wall puncture (CWP) versus intracystic puncture (ICP) in percutaneous vertebroplasty (PVP) for stage I and II Kümmell's disease. [Methods] A retrospective study was conducted on 56 patients who underwent PVP for stage I and II Kümmell's disease from March 2017 to February 2021. According to doctor-patient communication, 30 pa- tients received CWP-PVP, while the remaining 26 patients received ICP-PVP. The perioperative, follow-up and imaging data were com- pared between the two groups. [Results] All patients in both groups had corresponding procedure performed successfully without serious in- traoperative complications. Although there were no significant differences in the operation time, first puncture success rate, bone cement leakage rate, walking time and hospital stay between the two groups (P＞0.05), the CWP group had significantly more intraoperative fluorosco- py times [(12.4±1.6) times vs (9.2±1.7) times, P＜0.05] and significantly more bone cement injected [(4.7±0.2) ml vs (4.3±0.2) ml, P＜0.05] than the ICP group. With time of follow-up lasted for (17.4±2.4) months on an average, the VAS and ODI scores significantly decreased in both groups (P＜0.05), which were not statistically significant between the two groups at any time points accordingly (P＞0.05). Radiographi- cally, the Cobb angle, anterior and midline vertebral heights of injured vertebra were significantly improved in both groups at 3 days postoper- atively and the last follow-up (P＜0.05). There was no significant difference in the above imaging indexes between the two groups before sur- gery (P＞0.05), however, the CWP group proved significantly superior to the ICP group in terms of anterior vertebral height [3 days postopera- tively (20.5±1.9) mm vs (19.5±1.7) mm, P＜0.05; the last follow-up (20.1±1.9) mm vs (18.0±2.0) mm, P＜0.05], the middle vertebral height [3 days postoperatively (18.0±1.4) mm vs (17.2±1.2) mm, P＜0.05; the last follow-up (17.5±1.4) mm vs (16.6±1.2) mm, P＜0.05], and the local kyphotic angle [3 days postoperatively (13.9± 4.2) ° vs (16.5±5.4) °, P＜0.05; the latest follow-up (14.4±4.6) ° vs (17.9±5.7) °, P＜0.05]. [Con- clusion] The unilateral cyst-wall-puncture percutaneous vertebroplasty does achieve considerably better consequences to recover and main- tain morphology of the affected vertebrae than the intracystic counterpart for stage I and II Kümmell's disease.