Abstract:[Objective] To introduce the surgical technique and preliminary clinical outcomes of unilateral extrapedicular percutaneous kyphoplasty (PKP) for the treatment of osteoporotic vertebral compression fractures (OVCF). [Methods] A total of 26 patients received unilateral extrapedicular percutaneous kyphoplasty for OVCF. The puncture needle was gradually punctured along the puncture point to the outer edge of the pedicle, and the puncture needle was adjusted. As puncture needle tip was located at the outer edge of the pedicle on the anteroposterior (AP) image, and the needle tip was adjusted to locate at the median line of the pedicle on the lateral image, then the needle was inserted about 1 cm parallel to the upper endplate. Subsequently, a trephine was inserted and advanced about 2 cm before removed. A balloon was placed along the puncture working cannula, then was slowly expanded to recover at the height of the collapsed vertebral body. After the balloon was withdrawn, and the bone cement injector was used to push the bone cement into the vertebral body at low pressure with caution until the vertebral body was filled. [Results] All the 26 patients had the extrapedicular PKP performed successfully with 1 case of bone cement leakage, 1 case of knife edge infection, 2 cases of skin edge necrosis, 3 cases of knife edge hematoma. Follow-up period lasted from 6 months to 3 years, with an average of 1.6 years. All patients got significant pain relief and regain daily life activity capacity, except 2 cases who were found new onset of fractures in other vertebrae, were given PKP again and got satisfactory recovery. No death or other serious complications occurred in anyone of them. [Conclusion] Unilateral extrapedicular percutaneous kyphoplasty for the treatment of osteoporotic vertebral compression fractures is feasible with shortened operation time and reliable outcomes.