Abstract: Objective To study the clinical efficacy and safety of manipulative reduction combined with percutaneous vertebroplasty in the treatment of severe vertebral fractures in the elderly. Methods A total of 214 patients with severe vertebral fracture from July 2011 to July 2013 were selected and divided into observation group and control group with 107 cases in each group. The control group was treated with PVP surgery, and the observation group was treated with manual reduction plus surgical treatment. Regular follow-up was conducted one month after the operation and ended in October 2017. The total effective rate was compared between the two groups, and the postoperative leakage of bone cement, adjacent vertebral fracture rates, and vertebral fractures recurrence rate at different time points after surgery were observed. Results The total effective rate of observation group was significantly higher than that of control group (91.59% vs 79.44%, P=0.012), while the total incidence of bone cement leakage and the incidence of adjacent vertebral fractures in observation group was significantly lower than that in control group (7.48% vs 23.36%, P=0.001; 1.87% vs 8.41%, P=0.030). There was no significant difference in recurrence rate of vertebral compression fracture between the two groups at 1 and 3 months after surgery (P> 0.05). After 6 months, the incidence of fractures in both groups increased gradually, and it was higher in the control group than that in the observation group (6.54% vs 18.69%, P=0.007). Conclusion Manipulative reduction combined with percutaneous vertebroplasty decreases the incidence of leakage of bone cement, adjacent vertebral fracture rates and vertebral fractures recurrence rate in treatment of severe vertebral fractures in elderly people, which can be used as an effective and safe method for elderly people with severe vertebral fracture.