Hydatid Disease of the Lumbar Spine: Combined Surgical and Medical Treatment—A Case Report

Abstract not available. Introduction provided instead.

Larval forms of the cestode worm Echinococcus cause hydatid disease. The life cycle of the parasite often involves dogs as final hosts and human beings and sheep as intermediate hosts; therefore, the disease is prevalent in sheep-raising countries (eg, the Middle East and Turkey). Human beings become infected by ingesting water or food contaminated by the parasite eggs. After the eggs hatch in the intestine, they migrate through the portal venous system to settle in the liver and lungs in most cases.¹ Rarely, the parasite reaches the systemic circulation. Spinal involvement represents 0.5% to 1% of all cases of echinococcosis. Spinal infection represents about 44% of skeletal echinococcal cysts.² Cysts are common in the dorsal spine, followed by lumbar and sacral sites.³

Hydatid disease of the spine could occur by direct extension from pulmonary or pelvic infestation; less commonly, it starts primarily in the vertebral body. In spinal involvement, the compression of neural tissue with resulting neurological deficit is relatively common.⁴

The treatment recommended is decompression of the neural tissue, excision of the cyst with or without stabilization, and postoperative antihelminthic drug therapy for a long duration to prevent late recurrence.⁵

Conclusions as to the best postoperative regimen with minimal side effects and easy patient compliance are not available yet because hydatid disease is a rare condition and too few cases occur to obtain proper statistics.⁵ Medical treatment could be in the form of albendazole or mebendazole, with or without praziquantel.⁶ Early discontinuation of medical treatment—with risk of recurrence—could be due to the gastrointestinal disturbances or hepatic side effects or the long duration of treatment needed.^5-8

We present a case of primary hydatid disease of the lumbar spine with no other organ involvement. The patient was treated by surgical excision followed by medical treatment in the form of albendazole for 1.5 years postoperatively. The patient now has been followed up for 6 years postoperatively with no recurrence.