Abstract: Objective To analyze and explore the causes of bone cement leakage in percutaneous vertebroplasty (PVP). Methods Clinical data about 105 (146 vertebrae) patients who were treated by percutaneous vertebroplasty in our department from March 2011 to February 2014 were retrospectively analyzed. Postoperative X-ray and CT examination were performed in order to observe the bone cement leakage and analyze the related causes. Results The bone cement leaked in 47 (63 vertebrae) patients with 4 cases in vertebral canal, 4 cases in neural foramen, 8 cases in intervertebral disk, 10 cases on the side of the vertebrae, 7 cases in veins and the other 14 cases at the site of the puncture, and the rate of leakage was 43.15%. The main reasons of the bone cement leakage were inaccurate needle direction in 15 cases, repeated puncture in 13 cases, inappropriate time of bone cement injection in 9 cases, excessive amount of bone cement injection in 7 cases, and unclear imaging equipment in 3 cases. Conclusion Cement leakage is a common complication of PVP. This study shows that the main reasons of the bone cement leakage are inaccurate needle direction, repeated puncture, inappropriate time of bone cement injection, excessive amount of bone cement injection, and unclear imaging equipment.