Primary non-Hodgkin's lymphoma of the vertebra is rare in the spine of the elderly. The clinical presentation and radiological features are unspecific, which make it more difficult for diagnosis. We report a case of a 79-year-old woman complaining of serious backache without any injury. The magnetic resonance imaging (MRI) showed invasion of the fifth thoracic vertebra with the posterior vertebral body wall defect. There was a high suspicion that the patient had a metastatic tumor of the vertebra. A percutaneous vertebroplasty was performed under fluoroscopic guidance, which was used to treat the osteoporotic vertebral compression fracture, vertebral metastases, verte-bral hemangioma, and multiple myeloma. The pain was rapidly and conspicuously relieved after the procedure. The visual analog scale (VAS) score decreased from 8 preoperatively to 2 postoperatively. The imaging examination postoperatively revealed a small amount cement leaking into the spinal canal, but there were no symptoms and no complications in our patient. During vertebroplasty, a biopsy was done by biopsy needle before injection of the cement (polymethyl methacrylate). The histopathological examination revealed a diffuse large B-cell lymphoma. No new evidence of any other lesion was found during a 6-month follow-up period. The patient was diagnosed with primary bone lymphoma finally. Due to the previous condition of the patient, R-miniCHOP chemotherapy was applied following the surgery in the department of hematology. Until the 9 months follow-up, the clinical result was still satisfactory.