One hundred ninety-seven patients with unstable osteoporotic vertebral compression fractures were randomized to receive either percutaneous kyphoplasty alone (PKP; n=106) or PKP plus percutaneous cement-augmented screw fixation (n=91). The primary outcome of interest was pain relief measured by the visual analogue scale (VAS) at 7 days postoperatively. Secondary outcomes included restoration of vertebral height, correction of posterior convexity deformity, Oswestry Disability Index (ODI) scores, and Japanese Orthopaedic Association (JOA) scores. Outcomes were assessed up to 6-13 months postoperatively. Overall, the results of the study revealed that PKP plus percutaneous cement-augmented screw fixation provided superior pain relief, restoration of vertebral height, and correction of posterior convexity deformity compared to PKP alone.