Is Less More? Limited Surgery Is Insufficient in the Treatment of Spinal Hydatid Cysts

Background/Objectives: Spinal hydatid disease frequently poses significant surgical challenges and leads to severe neurological complications. Despite the development of various surgical techniques, recurrence remains a common issue. The aim of this study was to evaluate the impacts of radical vertebrectomy on recurrence and long-term follow-up outcomes by comparing total en-bloc spondylectomy with conventional laminectomy, decompression, and posterior stabilisation in patients treated at our centre. Methods: This study included 21 patients who underwent surgery for spinal hydatid cysts at our centre between 2001 and 2021. Twelve patients had cystectomy, laminectomy, decompression, and stabilisation, and nine patients had total en-bloc spondylectomy. A single senior surgeon carried out each procedure, selecting the surgical approach based on the presence of vertebral body involvement. All patients received albendazole treatment for six months following surgery. The surgeon who performed the operations followed up all patients clinically and radiologically for at least three years. Results: Seven out of twelve patients (58.3%) who had conventional surgery experienced recurrences, while total en-bloc spondylectomy produced no recurrences (p = 0.004). The recurrent cases had a mean of 2.8 surgical procedures and manifested within 14 months. Although total en-bloc spondylectomy was associated with a longer operative time and greater blood loss, neurological recovery and overall clinical outcomes were comparable between the two groups. The difference in the recurrence rate was statistically significant. Conclusions: Although technically demanding, radical vertebrectomy is shown to provide complete protection against recurrence in appropriately selected patients with spinal hydatid disease in this study. Furthermore, as conservative approaches often require multiple procedures, total en-bloc spondylectomy can be considered an effective treatment for patients with vertebral body involvement.