Objective To improve the therapeutic results of multilevel osteoporotic vertebral compression fracture in the elderly with modified percutaneous kyphoplasty(PKP) technique. Methods Forty-eight patients over 60 years suffering from multilevel (3 or more levels) vertebral compression fracture were divided into two groups: common PKP group(group C) and modified PKP group(group M). In group C, there were 20 patients with 82 vertebraes from T5-L5. Three to six surgical levels (average 4.1 levels) were processed with routine PKP technique. In group M, there were 28 cases with 112 vertebraes from T4-S1. Three to seven surgical levels were processed with modified PKP technique. Local anesthesia was performed in both groups. Dexamethasone(20mg) was used in group M. Additional puncture were carried out if the distribution of bone cements was not satisfactory. The visual analog scale(VAS) scores, duration of surgical procedure, volume of bone cements, rate of leaking and clinical complications were analyzed and compared between the two groups. Results The VAS scores were (8.6±2.3) and (8.2±1.9) before the surgery, and (3.5±2.6) and (3.2±3.0) at 3 days after surgery in group C and group M respectively. There was no significant difference between the two groups. Fourteen vertebral bodies were processed in both sides in group C(15.73%), and only 1 vertebral body was processed in both sides in group M(0.89%)（P＜0.0001）. The volume of bone cements was 8.0-23.1（15.3±3.1）ml in group C and 8.5-25.5（16.2±4.1）ml in group M. The leaking rate of cements was 19.5% in group C and 18.75% in group M. The duration of surgical procedures was 70-230min [(26.9±6.7)min/level] in group C and 45-162 min[ (16.3±5.2)min/level] （P＜0.001）. No clinical complication was observed in either group. Conclusion Modified PKP technique can shorten the duration of surgical procedures and allow less puncture. It is safe to keep the volume of injection under 26ml.