Objective: To explore the therapeutic effect of pedicle screw fixation combined with surgical methods in patients with severe osteoporosis and compression vertebral fractures (OVCF). Methods: Eighty-two patients with severe osteoporosis and OVCF admitted to our hospital from January 2023 to January 2024 were selected as study subjects. They were randomly divided into a control group (n = 41) receiving conventional conservative treatment and an observation group (n = 41) undergoing pedicle screw fixation combined with vertebroplasty. The treatment effects and overall patient satisfaction rates were compared between the two groups three months after surgery. Results: The total effective rate of the observation group was 97.56% (40/41), significantly higher than the 70.73% (29/41) of the control group (P < 0.05). Additionally, the overall satisfaction rate of the observation group was significantly higher than that of the control group (P < 0.05). Conclusion: Pedicle screw fixation combined with vertebroplasty is significantly effective in treating severe OVCF, with higher patient satisfaction, and is worthy of promotion.