Características radiológicas y quirúrgicas de un caso de hidatidosis espinal recurrente

Abstract

Hydatidosis is an illness that is still to be found in our setting. The lungs and liver are the organs most frequently involved and it rarely extends to bones. Involvement of the spine is infrequent, but it can give rise to a high degree of disability and may recur despite apparently complete excision. Here we report a case of recurring spinal hydatidosis with radiological and surgical particularities. Our case involves a 63-year-old male living in a rural area of the northern part of Spain's central plateau. The patient had a history of surgery for spinal hydatidosis and was on treatment with mebendazole. In the months before his visit, the patient had experienced difficulty in walking and urgency incontinence. The examination revealed paraparesis that predominantly affected the right-hand side and the patient required bilateral support to be able to walk. A dorso-lumbar magnetic resonance scan showed post-surgery changes with pedicular instrumentation added later in another centre, and a hydatid cyst with involvement of the body of the D10 vertebra, epidural extension and compression of the spinal cord. The patient was submitted to a surgical procedure involving the extraction of the system of fixation and full macroscopic excision of the cyst, with partial resection of the body of the vertebra. Initially the patient displayed motor improvement and treatment with mebendazole was reintroduced in high doses. Spinal hydatidosis is a rare condition that, in spite of correct surgical and medical treatment, often recurs. Magnetic resonance scans show characteristic 'honeycomb' images, which are sometimes large and have their origins in the body of the vertebra. Although successive surgical interventions can become increasingly more difficult because of old instrumentation or the conservation of compromised vertebral bodies, aggressive excision is indicated while the patient still has useful neurological functioning.