Residual and recurrent spinal echinococcosis: MRI and intraoperative correlation in two patients

Spinal echinococcosis is a rare manifestation of hydatid disease with potentially debilitating neurological consequences. We present two cases of spinal echinococcosis: one depicting residual disease postsurgical decompression and the other representing recurrence after prior spinal hydatid surgery. Case 1, an early 60s male, underwent posterior decompression and laminectomy for cauda equina compression due to multicompartment extradural cysts. Despite surgical clearance, a single residual cyst was noted on follow-up MRI and managed medically. Case 2, a mid-20s female, presented 3 years after initial spinal hydatid surgery with imaging-confirmed recurrence, extending into prevertebral, paraspinal and iliac compartments. Both cases were treated with albendazole (15 mg/kg/day). We highlight the classical imaging features on MRI and CT, surgical observations and the importance of vigilant follow-up. Early diagnosis and multimodal management are crucial in preventing irreversible neurological deficits.