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Purpose: To evaluate the safety and the clinical efficacy of percutaneous vertebroplasty (PVP) in treating malignant spinal tumors and malignant vertebral compression fractures with epidural involvement.Materials and methods: 43 patients with spinal metastatic tumors and malignant vertebral compression fractures with epidural involvement were treated using PVP.American Spinal Injury Association (ASIA) impairment scale results at presentation were used to divide patients into 2 groups.Patients in group A had no symptoms of neurological compression (n =25);and patients in group B had symptoms of neurological compression (n =28).A 13G bone puncture needle was placed across the pedicle of the fractured vertebra,and polymethyl methacrylate (PMMA) was injected into the fractured vertebral body under fluoroscopic control.Patients were seen in follow-up at 1,3,and 6 months after the procedure and every six months thereafter.Results: PVP was technically successful and well-tolerated in all patients.Clinical assessment at the final follow-up found complete pain relief (n =19) or good pain relief (n =14) in 33 patients (62.3％,95％ CI: 49％,76％).ASIA impairment scale assessment at the final follow-up demonstrated symptoms of neurologic compression in 31 patients and no symptoms of neurologic compression in 22 patients.Symptoms of neurologic compression were found in five group A patients and eight group B patients.Conclusions: PVP was a safe and moderately effective procedure in the treatment of malignant vertebral compression fractures with epidural involvement.