Objective To evaluate the clinical outcomes and efficiency of the unipedicular percutaneous kyphoplasty(PKP) in vertebral fragility fractures. Methods A prospective observational study was performed. Twenty patients with a total of 34 vertebral compression fractures underwent kyphoplasty utilizing a unilateral pedicular/unipedicular approach. The vertebral bodies were measured at the anterior margins. And visual analog scale(VAS), Cobb￠s angle were compared preoperatively, at day 2 and the end of follow-up postoperatively. Complications were recorded. Height restoration, pain relief and Cobb￠s angle change were assessed pre- and post-operatively. Results Twenty patients underwent unipedicular PKP for a total of 34 levels. The mean duration of follow-up was 15.5 months (ranging 10 to 20 months). The mean pre-operative anterior vertebral height was (17.68±3.33)mm and postoperative one was (30.94±3.22)mm, which was significantly different (P＜0.05). The mean VAS was (7.15±1.17), (2.20±0.53) and (2.10±0.45) preoperatively, at day 2, and at the end of follow-up respectively, with significant difference between the 3 time points (P＜0.05). The VAS change had no statistica1 significance between day 2 and the end of follow-up time point (P＞0.05). The Cobb￠s angle decreased from (21.53°±5.22°) to (7.35°±2.16°), with statistical significance (P＜0.05). Cement extravagation was observed in one asymptomatic case (2.9%). Adjacent vertebral fractures were observed on 2 levels (5.9%) in 2 cases, who underwent kyphoplasty again. Conclusions Unipedicular PKP is both a safe and efficacious alternative to the traditional bipedicular kyphoplasty for the treatment of painful vertebral fragility fractures. And it is comparable with bipedicular kyphoplasty in height restoration, pain relief and Cobb￠s angle change. And also, it is faster, less expensive and involves less radiation exposure for the patient. It improves the life quality of the involved elderly cases.