Objective To analyze the value of different surgeries in elderly patients with osteoporotic thoracolumbar compression fractures. Methods: 100 patients with osteoporotic thoracolumbar compression fractures admitted to our hospital from October 2019 to October 2024 were selected as the research subjects. The patients were randomly divided into the control group and the observation group, with 50 cases in each group. The control group was treated with percutaneous vertebroplasty. The observation group was treated with percutaneous kyphoplasty. The perioperative indicators, pain degree [Visual Analogue Scale (VAS)], degree of dysfunction [Oswestry Disability Index (ODI)], prognosis [anterior vertebral height, kyphotic Cobb Angle], inflammatory factors [matrix metalloproteinase-3 (MMP-3), matrix metalloproteinase-inhibitor-1 (TIMP-1), Interleukin-6 (IL-6)], complications and quality of life [Comprehensive Quality of Life Questionnaire 74 (GQOLI74)] of the two groups were analyzed and compared. Results: The operation time and hospital stay of the observation group were significantly shorter than those of the control group, and the injection volume of bone cement was significantly lower than that of the control group (P < 0.05). Three months after the operation, the VAS and ODI scores of both groups were significantly lower than those before the operation, and the VAS and ODI scores of the observation group were significantly lower than those of the control group (P < 0.05). Three months after the operation, the anterior edge height of the vertebral bodies in both groups was significantly increased compared with that before the operation, and the kyphotic Cobb Angle was significantly decreased compared with that before the operation. Moreover, the improvement amplitudes of the anterior edge height of the vertebral bodies and the kyphotic Cobb Angle in the observation group were significantly greater than those in the control group (P < 0.05). Three months after the operation, the levels of MMP-3 and IL-6 in both groups were significantly lower than those before the operation, and the level of TIMP-1 was significantly higher than that in the control group. Moreover, the improvement amplitudes of MMP-3, IL-6 and TIMP-1 levels in the observation group were significantly greater than those in the control group (P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P < 0.05). After the operation, the GQOLI74 scores of both groups were significantly increased compared with those before the operation, and the GQOLI74 score of the observation group was significantly higher than that of the control group (P < 0.05). Conclusion: Percutaneous kyphoplasty can improve perioperative indicators, alleviate pain and functional disorders, improve the prognosis of patients, reduce inflammation, decrease complications, and enhance the quality of life.