One hundred forty-five patients with single-level osteoporotic vertebral compression fractures (OVCFs) were randomized to unilateral dual-plane puncture percutaneous vertebroplasty (PVP) (n=74) or traditional puncture PVP (n=71). The primary outcome was vertebral re-collapse within 1 year. Secondary outcomes included cement distribution (endplate contact), changes in anterior vertebral height (AVH) and local kyphotic angle (LKA), Visual Analog Scale (VAS) pain, and Oswestry Disability Index (ODI). Outcomes were assessed pre-op; 1 day, 1 month, 3 months; and 1 year post-op (mean follow-up 14.8 months). Overall, the unilateral dual-plane technique achieved more full endplate contact and lowered re-collapse (18.9% vs 42.3%; p<0.01), with better 1-year VAS and ODI. These findings suggest that optimizing cement distribution to contact both endplates is a key mechanism to prevent re-collapse and improve longer-term clinical outcomes.