OBJECTIVE: To evaluate short-segment fixation (SSF), with or without advanced osteotomy, for treating thoracolumbar kyphosis caused by osteoporotic vertebral compression fractures (OVCFs). METHODS: This retrospective analysis included 28 patients with thoracolumbar kyphosis caused by OVCFs who underwent SSF at our hospital between 2017 and 2022. The change in the Cobb angle between standing and supine positions was measured to establish whether an advanced osteotomy was necessary. Bone mineral density (T-score) and related hematologic bone metabolism markers were recorded to assess the patient's osteoporosis status. The Cobb angle and sagittal plane parameters were measured before and after surgery to determine the orthopedic outcomes, and function was assessed using a visual analog scale and the Oswestry Disability Index. RESULTS: A total of 28 patients successfully underwent SSF with or without advanced osteotomy, with no serious complications. The mean follow-up period was 29 ± 3 months. The Cobb angle decreased significantly, from 45° ± 6° before surgery to 11° ± 3° at the last follow-up (P <
0.05). The visual analog scale scores and Oswestry Disability Index at the last follow-up were significantly improved compared with those before surgery (P <
0.05). Five patients developed low back pain within 6 months of surgery (proximal junctional kyphosis in 4 patients and internal fixation fractures in 1 patient), and 2 of these patients underwent a second surgery. In the long-term follow-up, 2 patients had proximal junctional kyphosis/distal junctional kyphosis after the re-trauma. The 21 remaining patients maintained good internal fixation at the last follow-up, with no broken screws or rods, loosening, or displacement. CONCLUSIONS: SSF, with or without advanced osteotomy, is an effective treatment for thoracolumbar kyphosis caused by OVCFs, achieving good orthopedic outcomes and improving the quality of life of patients. Continuous standardized anti-osteoporosis treatment is essential for long-term recovery.