Case Report

Spinal Hydatid Disease, a Rare but Existent Pathological Entity: Case Report and Review of the Literature

Authors: George S. Sapkas, MD, Theofilos G. Machinis, MD, George D. Chloros, MD, Kostas N. Fountas, MD, PHD, George S. Themistocleous, MD, George Vrettakos, MD

Abstract

Spinal hydatid disease is a not uncommon cause of spinal cord compression in endemic countries; however, involvement of the epidural space with sparing of the vertebral column is rare. Early diagnosis and surgical decompression with total removal of the hydatid lesion, when possible, is generally considered the standard of care for this disease. The authors describe a case of massive epidural hydatid disease without involvement of the vertebral column in a 62-year-old male patient, treated with a 2-stage surgical operation and administration of systemic albendazole. The literature is reviewed regarding the clinical features, diagnosis, treatment and prognosis of spinal echinococcosis.


Key Points


* Spinal hydatid disease may be a cause of cauda equina syndrome, especially in endemic countries.


* Massive affection of the epidural space without involvement of the vertebral column is possible.


* Removal of cysts in toto is possible when the vertebral bodies are not affected and should be considered the standard of care, along with antiheliminthic agents to decrease the risk of recurrence.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Fares Y, Khazim R, El Zaatari MM, et al. Spinal Hydatid Disease and its Neurological Complications.Scand J Infect Dis 2003;35:394–396.
 
2. Islekel S, Ersahin Y, Zileli M, et al. Spinal hydatid disease. Spinal Cord 1998;36:166–170.
 
3. Mingde Q, Zheshang H. Echinococcosis of the Central Nervous System. Chin Med J 1980;93:269–274.
 
4. Ozek MM. Complications of Central Nervous System Hydatid Disease. Pediatr Neurosurg1994;20:84–91.
 
5. Pamir MN, Ozduman K, Elmaci I. Spinal hydatid disease. Spinal Cord 2002;40:153–160.
 
6. Krajewski R, Stelmasiak Z. Cerebral hydatid cysts in children. Childs Nerv Syst 1991;7:154–155.
 
7. Micheli F, Lehkuniec E, Giannaula R, et al. Calcified Cerebral Hydatid Cyst. Eur Neurol 1987;27:1–4.
 
8. Turgut M, Bayulkem K. Cerebrovascular occlusive disease: hydatidosis. Child's Nerv Syst1998;14:697–699.
 
9. Bavbek M, Inci S, Tahta K, et al. Primary multiple spinal extradural hydatid cysts of the literature: case report and review. Paraplegia 1992;30:517–519.
 
10. Bhojraj SY, Shetty NR. Primary hydatid disease of the spine: an unusual cause of progressive paraplegia. J Neurosurg (Spine 2) 1999;91:216–218.
 
11. Hamdan TA, Al-Kaisy MA. Dumbbell Hydatid Cyst of the Spine. Case Report and Review of the Literature. Spine 2000;25:1296–1299.
 
12. Sapkas GS, Papagelopoulos PJ, Stathakopoulos DP, et al. Recurrent Paraplegia Caused by Spinal Echinococcosis. Orthopedics 2002;25:1087–1088.
 
13. Tekkok IH, Benli K. Primary Spinal Extradural Hydatid Disease: Report of a Case with Magnetic Resonance Characteristics and Pathological Correlation. Neurosurgery 1993;33:320–323.
 
14. Ozdemir HM, Ogun TC, Tasbas B. A Lasting Solution is Hard to Achieve in Primary Hydatid Disease of the Spine. Spine 2004;29:932–937.
 
15. Pamir MN, Akalan N, Ozgen T, et al. Spinal hydatid cysts. Surg Neurol 1984;21:54–57.
 
16. Bruschi F, Ortona R, Ioppolo S, et al. Immunochemical and Molecular Characterization of Vertebral Hydatid Fluid. Scand J Infect Dis 1999;31:322–323.
 
17. Lam KS, Faraj A, Mulholland RC, et al. Medical Decompression of Vertebral Hydatidosis. Spine1997;22:2050–2055.
 
18. Bettaieb A, Khaldi M, Ben Rhouma T, et al. Spinal Echinococcosis clinical study of 32 cases.Neurochirurgie 1978;24:205–210.
 
19. Turgut M. Hydatid Disease of the Spine: A Survey Study from Turkey. Infection 1997;25:221–226.
 
20. Baysefer A, Gonul E, Canakci Z, et al. Hydatid disease of the spine. Spinal Cord 1996;34:297–300.
 
21. Dew HR. Hydatid Disease. Its Pathology, Diagnosis and Treatment. Sydney, Australasian Medical Publishing Co Ltd, 1928, p 429.
 
22. Akhan O, Dincer A, Saatci I, et al. Spinal intradural hydatid cyst in a child. Br J Radiol1991;64:465–466.
 
23. Iplikcioglu AC, Kokes F, Bayar A, et al. Spinal invasion of pulmonary hydatidosis: computed tomography demonstration. Neurosurgery 1991;29:467–468.
 
24. Tsitouridis I, Dimitriadis AS. CT and MRI in vertebral hydatid disease. Eur Radiol 1997;7:1207–1210.
 
25. Singh P, Shankar S, Sharma BS, et al. MRI in Sacral Echinococcosis. J Comput Assist Tomogr2000;24:176–177.
 
26. Fahl M, Haddad FS, Huballah M, et al. Magnetic Resonance Imaging in Intradural and Extradural Spinal Echinococcosis. Clin Imaging 1994;18:179–183.
 
27. Ley A, Marti A. Intramedullary hydatid cysts. J Neurosurg 1970;33:257–259.
 
28. Ersahin Y, Mutluer S, Guzelbag E. Intracranial hydatid cysts in children. Neurosurgery1993;33:219–225.
 
29. Apt WL, Fierro JL, Calderon C, et al. Vertebral hydatid disease clinical experiences with 27 cases.J Neurosurg 1976;44:72–76.
 
30. Booz MY. The value of plain film findings in hydatid disease of bone. Clinical Radiology1993;47:265–268.
 
31. Natarajan S, Manoli S, Basnyat PS, et al. Spontaneous rupture of primary musculoskeletal hydatid cyst. Surgery 2001;132:533–534.
 
32. Killough KK, Lusbough WB, Harkey HL. Parasitic infestations of the spine. In: Osenbach RK, Zeidman SM (eds). Infections in Neurosurgery. Philadelphia, Lippincott & Raven, 1999, pp 305–339.
 
33. Berk C, Ciftci E, Erdogan A. MRI in primary intraspinal extradural Hydatid disease: case report.Neuroradiology 1998;40:390–392.
 
34. Tuzun M, Hekimoglu B. Hydatid Disease of the CNS. AJR 1998;171:1497–1500.
 
35. Chang KH, Han MH. MRI of CNS Parasitic Diseases. JMRI 1998;8:297–307.
 
36. Karray S, Zlitni M, Fowles JV, et al. Vertebral Hydatidosis and Paraplegia. J Bone Joint Surg1990;72:84–88.
 
37. Ogut AG, Kanberoglu K, Altug A, et al. CT and MRI in hydatid disease of cervical vertebrae.Neuroradiology 1992;34:430–432.
 
38. Parvaresh M, Moin H, Miles JB. Dumbbell hydatid cyst of the spine. Brit J Neurosurg 1996;10:211–213.
 
39. Perani D, Scotti G, Scialfa G, et al. Hydatid disease of spine. A case report. J Neurosurg Sci1983;27:55–58.
 
40. Karray S, Karray M, Zliini M, et al. Radical cure of vertebral hydatidosis. A case report. Acta Orthop. Belg 2004;70:80–83.
 
41. Mills TJ. Paraplegia due to hydatid disease. J Bone Joint Surg 1956;38B:884–891.
 
42. Deve F.L. Echinococcose Osseuse. Paris, Masson, 1948, p 236.
 
43. Garcia-Vicuna R, Carvajal I, Ortiz-Garcia A, et al. Primary Solitary Echinococcosis in Cervical Spine. Postsurgical Successful Outcome after long term albendazole treatment. Spine 2000;25:520–523.
 
44. Rao S, Parikh S, Kerr R. Echinococcal infestation of the spine in north America. Clin Orthop1991;271:164–169.
 
45. Erdincler P, Kaynar MY, Babuna O, et al. The role of mebendazole in the surgical treatment of central nervous system hydatid disease. Br J Neurosurg 1997;11:116–120.
 
46. Baykaner MK, Dogulu F, Ozturk G, et al. A viable residual spinal hydatid cyst cured with albendazole. J Neurosurg (Spine I) 2000;93:142–144.
 
47. Keller TM, Schweitzer JS, Helfend LK, et al. Treatment of Progressive Cervical Spinal Instability Secondary to Hydatid Disease. A case report. Spine 1997;22:915–919.