Spinal hydatid disease: diagnosis and management challenge of 20 cases

the aim of this study is to highlight the benefit of medical treatment in spinal hydatid disease. between 1984 and 1998, 20 cases of spinal hydatid disease were treated in our department. Plain x-ray was performed in all cases, computed tomography scan and myelography in 16 cases and 5 cases were explored by resonance imaging. Nineteen patients were surgically treated. Anthelmintic drugs [albendazole] were used parentally alone in 1 case and associated with surgery in 5 cases. We divided our patients into two groups: the first called "surgical group", has only surgical treatment without albendazole [14 patients] and the second, called "medicosurgical group" received albendazole alone or associated with surgical treatment [6 patients]. out of 20 cases, 11 were male and 9 were female. Patients' age ranged from 9 to 70 years, with an average of 32 years. The mean duration of symptoms before admission was six months. The most common sign was weakness in 18 cases; pain was present in 12 cases. The thoracic spine was involved in 9 cases, lumbar in 5 cases, thoraco-lumber in 2 cases, cervical, cervicothoracic and craniovertebral junction, in 1 case each. One vertebra was affected in 2 cases and more than one vertebra in 14 cases. The cyst was intradural but extra-medullary in 3 cases, epidural without vertebral involvement in one case. Evolution was characterised by total recovery in 4 cases without bone involvement. Among the 10 patients with vertebro epidural location, treated only surgically, 6 presented multiple recurrences and repeat surgery was often needed, 4 were totally or partially improved; 5 among the 6 patients who received anthelmintic drugs are living without evidence of recurrence during a period ranging from 1 to 6 years. we conclude that spinal hydatid is chracterised by a high rate of recurrence. Albebdazole used in our department since 1993, seems to change the course of the disease