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Background There are few comparative studies regarding kyphoplasty (KP) and vertebroplasty (VP) for the treatment of painful vertebral compression fractures (VCF) in patients with cancer.The purpose of this study is to retrospectively compare KP with VP in pain improvement,cement leakage incidence,and the cost of treatment of malignant VCF.Methods We performed a retrospective study of clinical data for 80 patients with multiple spinal metastases,treated with KP in 42 cases and VP in 38.Visual analog scale (VAS) scores were collected pre-operatively,post-operatively,at 1 month,6 months,and 1 year after treatment.Cement leakage was identified using fluoroscopy and CT scan.Total cost per patient was also collected.Results There was a significant difference between the pre-and post-operative VAS scores (7.4±2.0 to 3.8±1.6,P ＜0.001 in the KP group; 6.7±2.4 to 3.7±1.4,P ＜0.001 in the VP group),and was maintained at 1-year follow-up (3.2±1.4 in the KP group,3.1±1.3 in the VP group).However,the difference in VAS score between these two groups was insignificant at baseline and every follow-up assessment post-operatively (P ＞0.05).The incidence of cement leakage in the KP group was lower than that of the VP group (16.9％ (14/83) vs 30.3％ (23/76),P ＜0.05).However,none of the patients developed any symptoms.The length of postoperative hospital stay in the VP group was shorter than that of the KP group ((2.441.3)vs (5.3±1.9) days,P ＜0.05).Total hospital cost in the KP group was much higher than that of the VP group (RMB Yuan 8 492±3 332 vs RMB Yuan 3 173±1 341,P＜0.01).Conclusions VP and KP are both effective in providing pain relief for patients with cancer-related VCF.KP provides no greater degree of pain improvement.KP is associated with a lower rate of cement leakage compared with VP.VP is associated with lower cost and shorter postoperative hospital stay in China.