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<!-- <h1>Traitement des fractures vertébrales par kyphoplastie</h1> -->
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<h2>Le traitement des fractures vertébrales ostéoporotiques</h2>
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<p>Les fractures vertébrales peuvent ainsi survenir, parfois même après un traumatisme minime, et occasionner des douleurs nécessitant une hospitalisation, une impotence fonctionnelle rendant parfois la marche impossible, éventuellement une compression de la moelle épinière ou des racines nerveuses, une déformation de la colonne et des difficultés respiratoires par perte d’amplitude de la cage thoracique. L’évolution peut alors se faire vers une spirale d’altération des fonctions et de la qualité de vie, avec un taux de mortalité augmenté de près de 30% par rapport à une population normale du même âge.<br><br>
Le traitement classique de la fracture vertébrale ostéoporotique jusqu’à présent se composait de repos au lit, d’antalgiques et de corsets, et dans de rares cas, un traitement chirurgical à visée surtout décompressive. Ces traitements, contraignants, n’étaient pas toujours suivis, ni efficaces ou bien tolérés, d’où le développement nécessaire de nouvelles techniques.</p>
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<p>La kyphoplastie est ainsi apparue dans l’arsenal thérapeutique disponible pour traiter les fractures vertébrales. Il s’agit d’une intervention visant à soulager la douleur en stabilisant la fracture, et à réduire la déformation rachidienne en restaurant le plus possible la hauteur vertébrale. <br><br>
Elle consiste en la mise en place percutanée sous contrôle radioscopique de deux trocarts dans les pédicules de la vertèbre fracturée jusque dans le corps vertébral, d’y introduire un ballonnet qui une fois gonflé restaure la hauteur de la vertèbre.<br><br> On crée ainsi un espace dans lequel, une fois les ballonnets retirés, on pourra injecter sous faible pression du ciment à prise rapide qui permettra de stabiliser la fracture et de maintenir la correction de hauteur obtenue. L’intervention est réalisée sous anesthésie générale, mais est d’une durée limitée de l’ordre de 30 à 45 minutes par vertèbre.</p>
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<p>La kyphoplastie fait l’objet d’un remboursement conditionné qui ne s’applique malheureusement qu’à un nombre restreint d’indications.<br><br> Elle n’est donc remboursée que dans les cas de fractures ostéoporotiques présentant une perte de hauteur suffisante, une densitométrie osseuse attestant d’une ostéoporose sévère (-2,5 DS), une IRM avec signes d’œdème intravertébral, et après un délai de 8 semaines après la fracture.<br><br> Elle est aussi remboursée pour les fractures consécutives à une métastase de myélome. Les fractures tombant en dehors de ces conditions peuvent toutefois souvent être d’excellentes indications à un traitement par kyphoplastie, mais le coût du matériel sera alors à la charge du patient. <br><br>Le traitement des fractures vertébrales est donc un domaine en évolution constante, offrant de nouvelles possibilités aux patients souffrant de cette condition.</p>
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