[Hydatid cyst of the spine and spinal cord. Study of 24 cases]

In this retrospective study, we report our experience of severe hydatid disease located to the spine and the adjacent spinal cord observed in 24 cases between 1970 and 1994. In our series the sex ratio was predominant for males, and the mean age was 29 years. Clinically, the patients presented predominantly with a motor deficit. The diagnosis was assessed on radiological and biological investigations and was confirmed preoperatively. Hydatid serology was positive in 7 out of the ten cases explored. On standard X rays, the bone lesions were frequent: lysis in 10 cases, vertebral deformation in 3 cases, costal invasion in 5 cases, and paravertebral collection in 2 cases. These lesions were predominantly located at the thoracic level. Myelography confirmed a complete blockade in 8 out of 11 cases. When possible, the CT scan confirmed the bone lesion in all of the 10 cases explored, with an intrathecal cyst in 7 cases and a paravertebral collection in 8 cases. Magnetic resonance imaging was possible in one case only. Medical antihelminthic treatment was indicated as the sole treatment in one inoperable case. All the other patients were operated on, and the adjunctive specific medical treatment was associated in 5 cases. Using a posterior approach in 20 cases, the operative technique consisted in a complete removal (if possible) of the invaded bone and soft tissue, thus achieving a complete relief of the spinal cord compression. Complementary bone fixation was indicated in 2 cases. During the postoperative follow-up, two patients died from infection and trophic ulceration, 11 patients improved and 8 patients remained unchanged. In 5 cases, a reoperation was indicated and performed from 2 to 4 times. Three patients were lost for follow-up. The severity of this affection is confirmed in the literature. A complete recovery is quite exceptional. The best treatment remains an active nationwide prevention of the disease.