1. Enrico Piovan Neroradiology Dpt. Verona - Italy

2. SPINAL STRENGTHENING from Feb. 2003 to Sep. 2010 717 Procedures 546 Patients RATIO PROCEDURES / PATIENTS : 1,31 INDICATIONS

3. VERTEBROPLASTY OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES 370 Procedures 285 Patients RATIO PROCEDURES / PATIENTS : 1,30 AGE Min. 51 - Max. 97 Average : 74.4 years old

4. RISK OF SECONDARY VERTEBRAL FRACTURE FOLLOWING A VERTEBROPLASTIC TREATMENT Interventional observational study All 285 Patients Clinical retrospective observational study 33 Patients

5. INTERVENTIONAL STUDY ADJACENT LEVEL 28 Fractures in 285 Patients (10%) Patients age : Min. 58 – Max. 88 Average patiens age : 74.6 DISTANT LEVEL 14 Fractures in 285 Patients (5%) Patients age : Min. 60– Max. 85 Average patiens age : 74.1 DISK LEAKS 6 /28 5 % DISK LEAKS 4 / 14 4.2 %

6. INTERVENTIONAL STUDY RISK ADJACENT 9% year DISTANT 9.6% year NATURAL HISTORY25 % year

7. INTERVENTIONAL STUDY + - 18/28 sup. fr. 64.3% 10/28 inf. fr. 35.7% p < 0.05 9/14 sup. fr. 64.3% 5/14 inf. fr. 35.7% p < 0.1

8. CLINICAL STUDY 33 PATIENTS EVALUATED 1 TO 4 YEARS SINCE VERTEBROPLASTY IN 52% OF THE PATIENTS A NEW VERTEBRAL FRACTURES OCCURRED DURING FOLLOW-UP PATIENTS WITH NEW FRACTURE WERE SIGNIFICANTLY OLDER MEAN AGE 76 YRS VERSUS 70 YRS (P<0,05) AFTER VERTEBROPLASTY 27% NO SPECIFIC TREATMENT 73% BISPH. TREATMENT NEW FRACTURES 78% NEW FRACTURES 42%

9. CONCLUSIONS Severe back pain Natural history Medical treatment