Objective: To explore the application effect of 3D navigation-assisted percutaneous vertebra plasty (PVP) in osteoporotic vertebral compression fracture (OVCF) in the elderly. Methods: A total of 88 OVCF patients admitted to our department from February 2019 to June 2020 were divided into two groups by using the random number table method. The patients were randomly divided into a control group (n=44, PVP surgery guided by traditional C-arm X-ray machine) and an observation group (n=44, PVP surgery by 3D navigation). The number of successfully localized puncture, intraoperative fluoroscopy times and time, bone cement leakage rate and other conditions in the two groups were observed, and the changes of waist pain Visual Analogue Scale (VAS score), vertebra compression rate, and the Cobb Angle changes of injured vertebra before and 1 month after the treatment were compared. Results: After the treatment, the vertebral compression rate, Cobb Angle and VAS score of the injured vertebra in the two groups were significantly reduced compared with that before the treatment. The vertebral compression rate, injured vertebral Cobb Angle, and VAS score in the observation group were lower than those in the control group, and there were significant differences between the two groups (P<0.05). In the observation group, the intraoperative fluoroscopy time and operation time were shorter than those in the control group, the number of fluoroscopy times was less than that in the control group, the amount of bone cement injected was larger, and fluoroscopy radiation amount and the time needed for obtaining the ideal location were less or shorter than those in the control group (P<0.05). Both groups had pulmonary embolism, intraspinal hematoma, nerve root injury and other serious complications. The incidence of bone cement leakage in the observation group was lower than that in the control group, and the one-time success rate of positioning puncture was higher than that in the control group (P<0.05). There was no significant difference in the success rate of PVP technique between the two groups (P>0.05). Conclusion: 3D navigation-assisted percutaneous vertebroplasty can significantly promote the recovery of average vertebral height, reduce the amount of X-ray exposure, reduce the times of fluoroscopy, and shorten the operation time in the elderly osteoporotic vertebral compression fracture, which is worthy of promotion.