Objective To observe clinical efficacy of osteoporotic thoracolumbar compression fractures treated by manual reduction with percutaneous vertebroplasty. Methods Totally 82 patients with osteoporotic thoracolumbar compression fractures were randomly divided into treatment group (43 cases) and control group (39 cases). The treatment group received the manual reduction combined with percutaneous vertebral plasty, while the control group only received percutaneous vertebral plasty. Lumbar back pain VAS scores, vertebral anterior height and spine after convex Cobb angle before and after operation in the two groups were compared. Results There was statistical significance among VAS pain score, spine after convex Cobb angle and anterior flange height in the two groups (P<0.05); There was no statistical significance in VAS score in the two groups on the 2nd day. (P>0.05), while there was statistical significance in spine after convex Cobb angle and anterior flange height in the two groups (P<0.05);There was statistical significance among VAS pain score, spine after convex Cobb angle and anterior flange height in the two groups in the 3rd month after operation (P<0.05). Conclusion Manual reduction combined with percutaneous vertebral plasty can improve the lower back pain, restore vertebral body height and correct spine after contex Cobb angle of osteoporotic thoracolumbar compression fractures, which is better than pure percutaneous vertebral plasty.