30 patients with 1-2 osteoporotic vertebral compression fractures were randomized to vertebral augmentation surgery with either the SpineJack® implant or balloon kyphoplasty with the KyphX Xpander® implant. The purpose of the current study was to determine and compare 3-year outcome between groups. Clinical scores of visual analog pain scale and Oswestry Disability Index significantly favoured the SpineJack group compared to balloon kyphoplasty group. In addition, correction in anterior and middle vertebral body height ratio and kyphosis significantly favoured the SpineJack group. However, the comparisons for vertebral body height ratios may have been confounded by marked differences between groups at baseline.