Intramedullary hydatid cyst of the cervical spine.

Hydatid disease (Echinococcosis) is a common parasitic infection caused by Echinococcus granulosus mainly in sheep-raising areas of the world. Liver, lungs and brain are the predominantly involved organs. However, 0.5-1% of the hydatid disease involves the spine and in 90% of the cases it is confined to the bone and the epidural space. Although intramedullary involvement is extremely rare, in this report, we present a 55-year-old female patient who was diagnosed with a cervical intramedullary hydatid cyst during magnetic resonance imaging of the cervical vertebrae. Accordingly, we imply that particularly in endemic areas, hydatid cyst disease should be kept in mind for the differential diagnosis of spinal mass lesions.

Onchocercosis of an intervertebral joint capsule causing cervical vertebral stenotic myelopathy in a horse.

A novel case where onchocercosis was identified as a cause of cervical myelopathy in the horse is described. A 15-year-old Connemara mare was euthanized due to progressive locomotion disturbance. Postmortem examination revealed soft-tissue swelling in the intervertebral joint capsule of C6-7 with narrowing of the vertebral canal. On light microscopy, axonopathy was pronounced in the corresponding segment of the spinal cord. Fibrous tissue and eosinophilic granulomas were found in the joint capsule, together with parasites identified histologically as Onchocerca sp.

The cervical spine and its relation to anterior plate-screw fixation: a quantitative study.

Multilevel discectomy and inter-vertebral body fusion combined with anterior plate-screw fixation is the common procedure in cervical spine surgery. The correct placement of the screws is an important factor for the outcome of these operations. Yet no systematic approach has been undertaken to optimize the geometry of the fixation-plates regarding the position of the screw-perforations. In this study MRI scans of 50 consecutive patients were analyzed regarding the height of each segment (C3-C7), the anterior-posterior diameter of the vertebral body and the distance between the vertebral arteries. Based on this data we developed "Standard Spine Models". Using these models we designed two plates each for single and two-level surgery, and three plates each for three- and four-level surgery. These ten plates do fit the cervical spines of all 50 patients examined in this study. With these plates the screw-perforations could be positioned efficiently over the bodies of the concerned vertebrae. This should facilitate the selection of a plate and the positioning of the screws. Thus the surgeons might save time and the screws might be positioned more exactly and entirely in the vertebral bodies, ensuring a secure fixation.

Multiple hydatid cysts of the neck, the nasopharynx and the skull base revealing cervical vertebral hydatid disease.

Hydatid disease is caused by the parasitic tapeworm Echinococcus. This parasite in larval stage can thrive in many parts of the body, most commonly in the liver and the lung. Hydatid disease in the head and neck is uncommon and hydatid cyst presents rarely as a cervical mass. Cervical vertebral echinococcosis is rare. We report a 14-year-old girl with multiple cervical spine hydatid cysts of the C1-C2 vertebrae that spread into the surrounding paravertebral tissues and involve the nasopharynx and the skull base particularly the left jugular foramen. This process has caused a progressive swelling in the left side of the neck located in the retrostyloid compartment of the parapharyngeal space with paralysis of cranial nerves (VI, IX, X, XI, XII). The diagnosis was made based on the image obtained from CT and MRI examinations. Characteristics of this rare disease, diagnosis and treatment difficulty are discussed.

Sparganosis presenting as a lateral neck mass.

BACKGROUND: Cervical sparganosis is rare, and its rarity makes it difficult to be distinguished from tumors. A case of cervical sparganosis is reported. METHODS AND RESULTS: An 80-year-old man was initially seen with a painless lateral neck mass for 3 months, which was initially diagnosed as cervical lymphadenopathy. Laboratory studies revealed eosinophilia, and the patient recalled that he had frequently taken mountain water. Serologic study of human sparganosis by a monoclonal antibody-based competition enzyme-linked immunosorbent assay (ELISA) was positive. Surgical excision was performed, and the sparganosis was confirmed by histologic examination. CONCLUSIONS: Sparganosis should be considered in the differential diagnosis of soft tissue tumors, especially among patients who have frequently ingested mountain water and consumed raw snakes or frogs.

Factors predictive of subsequent deterioration in rheumatoid cervical myelopathy.

OBJECTIVE: To identify the features of rheumatoid cervical spine disease associated with deterioration resulting in the need for surgical intervention or death. PATIENTS AND METHODS: Patients with rheumatoid cervical myelopathy who underwent cervical spine magnetic resonance imaging (MRI) between 1991 and 1996 were identified. Patients requiring immediate surgical intervention were excluded. The remainder were divided into two groups. Deterioration group: patients requiring surgical intervention during the follow-up period and deaths resulting from cervical myelopathy. Conservative group: all other patients. Relevant clinical features and radiology reports were extracted retrospectively from the casesheet. RESULTS: The deterioration group comprised 11 patients (12%), median time to deterioration 15 months (range 4-84 months). The conservative group included 82 patients. Initial clinical features did not differ significantly between the two groups. Sixty per cent of those patients with compression or impingement at the atlanto-axial level on first MRI deteriorated over a median of 12 months (range 4-36 months). CONCLUSION: Deterioration is likely if there is evidence of cord compromise at the atlanto-axial level on MRI regardless of initial clinical and plain X-ray features.

Primary solitary Echinococcosis in cervical spine. Postsurgical successful outcome after long-term albendazole treatment.

STUDY DESIGN: A case report of a young man with isolated cervical hydatidosis treated postoperatively with sustained cyclical albendazole therapy for 9 years of follow-up. OBJECTIVES: To communicate the efficacy and safety of prolonged albendazole treatment in the postoperative management of spinal hydatid disease, and recommend therapeutic regimes for preventing its recurrence. SUMMARY AND BACKGROUND DATA: Bone involvement in hydatid disease is uncommon and the cervical region of the spine is rarely affected. Surgical excision remains the treatment of choice but high rates of postoperative recurrence have highlighted the importance of adjuvant anthelmintic therapy. The selection of the drug(s) and the duration of the medical treatment is still controversial. METHODS: The patient described herein presented with isolated bone lesions, in an unusual cervical location, and without coincidental visceral involvement. Therefore, diagnosis was delayed and surgical debridement was carried out without any preoperative anthelmintic therapy. To prevent late recurrences, therapy with intermittent courses of albendazole has been maintained for nine years and is still ongoing. Response and toxicity related to therapy has been closely monitored by clinical, biochemical and radiological follow up. RESULTS: After surgery the patient has remained asymptomatic without sequelae or evidence of relapses. No clinically relevant side effects has been observed. CONCLUSION: Prolonged albendazole treatment appears to be safe and effective in the prevention of late recurrences after spine hydatidosis surgery. Long-term chemotherapeutic schedules should be considered after surgical excision of spine or bone lesions.

Treatment of progressive cervical spinal instability secondary to hydatid disease. A case report.

STUDY DESIGN: A case report of a patient with progressive cervical spinal instability secondary to hydatid disease and the operative therapy. OBJECTIVE: To document how the combination of contemporary imaging, medical, and operative methods has obviated severe neurologic sequelae in a patient's cervical spine ravaged by hydatidosis. SUMMARY OF BACKGROUND DATA: The incidence of hydatid disease in the vertebral column is unusual and rare in the cervical spine. Until recently, patients with spinal hydatid disease have had guarded prognoses, because the various medical and surgical therapies could not effect curative or even palliative results. METHODS: The use of contemporary imaging methods, including computed tomography and magnetic resonance imaging, is described, in conjunction with current anthelminthic therapy and operative spinal instrumentation in this patient with recurrent quadriparesis from progressive hydatid spinal erosion. RESULTS: With the operative and medical therapies described in this case report, the patient has had six successful operative results in 6 years for cervical spinal hydatidosis and remains neurologically normal, with a stable cervical spine. CONCLUSIONS: It is hoped that this case presentation will justify a spirit of guarded optimism in the patient whose spine has been rendered unstable by hydatid disease and that, though a cure is still not likely, at least the past inexorable prognosis of paralysis and death is ameliorated.

CT and MRI in hydatid disease of cervical vertebrae.

Hydatid disease (HD) of the cervical spine is rare. A case investigated by computed tomography (CT) and magnetic resonance imaging (MRI) is presented. While CT shows the bone lesion better, MRI is superior in demonstrating compression of neural structures. The complementary use of CT and MRI in such cases is suggested.