Le fratture vertebrali

Le fratture vertebrali da compressione rappresentano l’evento clinico più comune causato dalla fragilità ossea. A causa della complessa eziologia del “mal di schiena”, le fratture vertebrali risultano spesso non diagnosticate e, di conseguenza, non trattate in maniera adeguata. Il Ministero della Salute ha stimato un numero superiore a 100.000 nuovi casi di frattura vertebrale in Italia ogni anno.

Definizione

La frattura vertebrale da compressione si verifica quando le vertebre si fratturano o collassano, non necessariamente a seguito di un trauma evidente.

Fratture vertebrali da compressione

Un peso sollevato distrattamente, un movimento brusco, talvolta solo l’essersi chinati troppo, rifacendo il letto al mattino: tutti gesti a prima vista innocui e invece suscettibili di provocare, nei soggetti predisposti, il cedimento e il collasso del corpo vertebrale. Fratture dolorose, che provocano cambiamenti nell’aspetto e nella postura, persistente mal di schiena, limitata mobilità e un generale decadimento fisico nei soggetti colpiti, il più delle volte ignari persino della causa del proprio male. 

Foto

Le fratture vertebrali, quali le cause – Una delle più frequenti cause di frattura del corpo vertebrale è l’osteoporosi, inesorabile e “silenziosa” malattia in rapida diffusione, a causa dell’invecchiamento della popolazione mondiale. Secondo stime recenti, si prevede che in Europa il 40% delle donne (8 su 20) e il 15% degli uomini di mezza età (3 su 20) soffriranno, nel corso della loro vita, di una o più fratture osteoporotiche. Un numero impressionante, come la frequenza con cui, nel continente Europeo, si incorre in frattura da osteoporosi: ogni 30 secondi. Le VCF possono anche essere la conseguenza di un evento traumatico, ad esempio una caduta o un incidente, di malattie del sangue (come il mieloma multiplo o la leucemia), di un tumore con metastasi alla colonna vertebrale (può avvenire in presenza di tumori solidi del seno, polmone, vescica, rene, prostata) oppure di terapie steroidee a lungo termine, quali quelle impiegate nella cura di alcune patologie dermatologiche o allergologiche, nel trattamento dell’artrite reumatoide o nei pazienti post-trapiantati. Nonostante il persistente dolore e una sempre più accentuata deformità toracica e lombare, chi ne è colpito stenta spesso a rendersene conto, confondendo i sintomi con un banale mal di schiena. Una frattura da compressione del corpo vertebrale non trattata corretamente aumenta di 5 volte il rischio di ulteriori fratture, con tutto ciò che questo comporta in termini di qualità della vita del paziente e costi socio-sanitari.

Diagnosi

È consigliabile riferire tempestivamente al proprio medico l’insorgenza di dolori insoliti alla schiena. La diagnosi precoce è possibile mediante l’esame obiettivo e l’esecuzione di accertamenti diagnostici strumentali, quali la radiografia, capace di rilevare la presenza di una frattura vertebrale da compressione.  L’esame radiografico permette di riconoscere la frattura somatica tramite la  deformazione del corpo vertebrale: nella fig sottostante si osserva a sinistra la presenza di fine irregolarità della limitante somatica superiore e la salienza del profilo corticale anteriore (indicato dalla freccia) espressione di minimo dislocamento anteriore del frammeto somatica superiore; nell’immagine a destra, eseguita a distanza di 15 mesi si osserva l’evoluzione peggiorativa della lesione testimoniata del collasso vertebrale.

La deformità vertebrale viene classificata da GENANT in tre gradi a seconda della riduzione dell’altezza della vertebra e tre classi secondo la morfologia della deformazione. Tale classificazione aiuta a definire la frattura e monitorare l’eventuale modificazione morfologica nel tempo della stessa.

La RM è l’unica metodica di diagnostica per immagini che consente di definire con buona approssimazione l’insorgenza della lesione traumatica: nei casi infatti di lesione acuta o subacuta la vertebra oltre ad apparire più o meno deformata appare interessata da edema perilesionale espressione di fenomeni flogistici osteoriparatori. Tale edema è ben visualizzabile nelle immagini T1 pesate, ancor meglio nelle immagini SPIR o STIR (con soppressione del grasso) T2 pesate. Nei casi in cui vi sia la deformazione ma non l’edema, la lesione fratturativa è definibile come consolidata e pertanto non responsabile di alcuna sintomatologia di ultima insorgenza.

Ma la RM come peraltro la TC è metodica fondamentale per escludere nella sede di frattura la presenza di lesioni ossee di tipo tumorale che indebolendo la struttura ossea possono favorire l’insorgenza della frattura. Nella diapositiva sottostante sono riassunti i principali rilievi semeiologici che orientano verso l’eziopatogenesi traumatica o da insufficienza (osteoporosi) e pertanto verso l’esclusione della presenta di tessuto neoformato.

Nella diapositiva sottostante si evidenzia la lesione fratturativa vertebrale su lesione otumorale focale: oltre a caratteristiche semeiologiche dell’intensità di segnale dell’area vertebrale interessata dalla frattura, e dalla sua distribuzione (che nelle in presenza di tessuto patologico risulta non interessare completamente la vertebra) viene portato l’esempio patognomonico per la presenza della lesione ossea determinato dal rigonfiamento del muro somatico posteriore.

Accenni di terapia: solitamente, in caso di dolori alla schiena dovuti a frattura vertebrale, il paziente è sottoposto ad un trattamento conservativo, che contempla la prescrizione di un busto semirigido, l’immobilizzazione prolungata e l’assunzione di farmaci antinfiammatori e antidolorifici. Una soluzione simile, tuttavia, può non essere sempre sufficiente a risolvere il problema, perché il dolore può persistere anche diversi mesi e, soprattutto, il paziente non recupera la postura corretta. La Cifoplastica con Palloncino, intrinsecamente sicura per caratteristiche e dinamiche d’azione, consente di alleviare immediatamente il dolore, assicurando inoltre un buon recupero dell’altezza della vertebra.SDB

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