Objective To investigate the influencing factors of residual low back pain after treatment with Percutaneous Pedicle Screw Fixation (PPS) in Vertebral Compression Fracture (VCF) patients. Methods 80 VCF patients who received PPS treatment in our hospital from January 2021 to December 2024 were selected as the study objects. The incidence of patients with residual low back pain was analyzed and the patients were divided into pain group (with residual low back pain) and painless group (without residual low back pain) according to whether the patients had residual low back pain. Baseline data were collected and compared between the two groups. Univariate and multivariate Logistic regression models were used to analyze the influencing factors of residual low back pain after PPS treatment. The prediction model was constructed and the Receiver Operating Characteristic (ROC) curve was used to analyze the efficiency of the prediction model. Results Among 80 PPS patients, 9 patients had residual low back pain (11.25%). There was no significant difference in gender, BMI, long-term drinking history and fracture site between pain group and painless group (P>0.05). Age, fascia injury rate, long-term smoking history ratio and vertebral compression rate in pain group were significantly higher than those in painless group, BMD T-score and good treatment compliance rate were significantly lower than those in painless group (P<0.05). Multivariate Logistic regression analysis showed that age, long-term smoking history, BMD T-score, fascia injury, vertebral compression rate and treatment compliance were the risk factors for residual low back pain. According to the analysis results, a risk prediction model was constructed: Log (P) =1.584× age +1.297× long-term smoking history +1.403×BMD T-score+1.392× fascia injury +1.349× vertebral compression rate +1.421× treatment compliance -24.812. The area under ROC curve of this model for predicting residual low back pain in VCF patients after PPS treatment was AUC=0.885 (95%CI 0.810~0.960) (P<0.05), and the sensitivity and specificity of this model were 71.20% and 90.40%, respectively. Conclusion The occurrence of residual low back pain after PPS treatment in VCF patients is affected by many factors, such as age, long smoking history, BMD T-score, fascia injury, vertebral compression rate and treatment compliance. Clinical intervention measures can be taken accordingly.