Hydatid disease affecting the vertebrae

Abstract

Six cases of hydatid disease affecting the vertebrae are described. Four patients presented with paraparesis and sphincter disturbances while the other two presented with low back pain and sciatica. Myelographic findings were positive in all six patients. The CT scans showed a paravertebral mass with destruction of bone in two cases. The nuclear magnetic resonance performed in one patient showed the exact extent of the disease all along the spine. Posterior laminectomy with decompression of the spinal cord and removal of the hydatid cysts was performed in all six patients. After the operation four patients received oral treatment with mebendazole. The patients with paraparesis showed little improvement of their neurological status. The two patients with low back pain and sciatica showed marked improvement. Hydatid disease affecting the vertebrae presents with neurological complications due to cord compression. The prognosis remains poor in spite of laminectomy, although removal of the hydatid cysts and long-term mebendazole medication may result in relief of symptoms.

Spinal hydatid disease

“…It only shows an extradural lesion, blocking the subarachnoid space. Koutzanis et al 16 have shown an accidental puncture of a paravertebral cyst and its diagnostic value. Myelography can be hazardous, since the puncture of a cyst may lead to the intradural spreading of the disease.…”

“…More frequently, the cyst gradually enlarges. 2,16 In 1928 Dew 17 has classi®ed spinal hydatid cysts into ®ve groups: Primary cysts of the spinal cord (intramedullary hydatid cysts), primary intradural cysts (intradural extramedullary hydatid cysts), primary extradural cysts, hydatid cysts of the vertebra and paravertebral lesions extending to the spinal column.…”

“…5,16 Grisel and Deve 22 stated radicular pain as the ®rst complaint. In our cases, back pain in 11 (85%) and lower extremity weakness in 10 (77%) patients were the main complaints and radicular pain was present in only 8 (62%) patients.…”

Spinal hydatid disease

“…29 Although plain X-rays are not diagnostic of the disease,`moth eaten' lesions with surrounding sclerosis and calci®cations extending into paravertebral soft tissues, when present, are highly suggestive. Bone changes are reported to be present in only 27% of cases.…”

“…1,7,10,12,14,25,26,29 More extensive lesions with involvement of the vertebral body can be approached via a transpedicular route. 26 Three cases of anterior approach to thoracic lesions were reported.…”