Objective To investigate the feasibility and effectiveness of selective treatment of senile osteoporotic thoracolumbar burst fractures of Denis type B with kyphoplasty and Jack vertebral dilator. Methods Between August 2007 and May 2011, 30 patients (32 vertebra) with osteoporotic thoracolumbar burst fractures of Denis type B were treated with kyphoplasty and Jack vertebral dilator. There were 7 males and 23 females, aged 57-85 years (mean, 76.9 years). The injured vertebrae included T11 in 2 vertebrae, T12 in 11 vertebrae, L1 in 7 vertebrae, L2 in 5 vertebrae, L3 in 3 vertebrae, and L4 in 4 vertebrae. The visual analogue scale (VAS) score, Oswestry disability index (ODI), the anterior and middle height of the vertebral body, and the Cobb angle were assessed before and after operation. Results The operation was completed smoothly in all cases; no cement leakage or intraoperative complication was found. Obvious back pain relief was achieved in all patients after operation. Thirty patients were followed up at 1 week and 6 months after operation. The VAS score was decreased from 8.2 ± 1.3 before operation to 1.5 ± 0.9 at 1 week after operation and 1.9 ± 0.5 at 6 months after operation; the ODI was decreased from 82.4% ± 15.0% to 17.8% ± 9.5% and 23.0% ± 8.6%; the anterior height of the vertebral body was increased from (19.5 ± 3.2) mm to (24.8 ± 3.0) mm and (24.0 ± 2.6) mm; the middle height of the vertebral body was increased from (18.5 ± 3.4) mm to (23.7 ± 3.7) mm and (22.8 ± 3.5) mm; the Cobb angle was decreased from (14.9± 7.5)° to (7.6 ± 6.0)° and (8.3 ± 6.0)°; and there were significant differences in the VAS score, ODI, the anterior and middle height of the vertebral body, and the Cobb angle between at pre- and at post-operation (P lt; 0.05), but no significant difference between at 1 week and at 6 months after operation (P gt; 0.05). Conclusion Kyphoplasty with Jack vertebral dilator for selective treatment of senile osteoporotic thoracolumbar burst fractures of Denis type B can restore the anterior and middle height of the vertebral body, correct the Cobb angle, and relieve pain, and it has good short-term effectiveness and safety.