There are several controversial challenges in the treatment of compression vertebral fractures in patients with osteoporosis, one of the main issues of treatment is the optimal surgical approach selection with the minimal risk of complications. Percutaneous vertebral augmentation modalities such as Percutaneous Vertebroplasty (PVP) and Percutaneous Kyphoplasty (PKP) are minimally invasive surgical procedures for treating painful compression vertebral fractures in patients with osteoporosis. Specific complications of vertebral augmentation modalities (PVP/PKP) are associated with the high risk of bone cement leakage. Prevention and management of complications related to the PVP/PKP are important challenges for the spine surgeons to date. The assessment of risk factors such as Intervertebral Cleft (IVC), cortical disruption, cement viscosity, and injected cement volume can prevent the complications related to the PVP/PKP. To optimize the benefits of PVP/PKP the risk analysis of each complication should be made, and appropriate treatment strategies of complications related to PVP/PKP should be established.