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CASE REPORT Table of Contents   
Year : 2004  |  Volume : 38  |  Issue : 2  |  Page : 132-133
Hydatid cyst of spine- a case report


Department of Orthopaedics, NRS Medical College, Kolkata, India

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How to cite this article:
Maity G N, Biswas R K, Pal A K, Banerjee K, Acharyya B. Hydatid cyst of spine- a case report. Indian J Orthop 2004;38:132-3

How to cite this URL:
Maity G N, Biswas R K, Pal A K, Banerjee K, Acharyya B. Hydatid cyst of spine- a case report. Indian J Orthop [serial online] 2004 [cited 2019 Dec 15];38:132-3. Available from: http://www.ijoonline.com/text.asp?2004/38/2/132/40930

   Introduction Top


Hydatid cyst of spine is a rare entity, but produce severe morbidity, therefore careful vigilance is mandatory for its early diagnosis and proper management. Previous reports revealed that hydatid disease presents as cystic compressive lesion of spinal cord with paraplegia, usually affecting middorsal region rarely the lumber vertebrae. [1],[2],[3],[4],[5] Most of the reported cases were located extradurally [4],[6],[7],[8] , rarely subdural [8],[9] . Their unsatisfactory neurological recovery even after decompression of the cord with or without laminectomy are mostly due to incomplete eradication or recurrence of the lesion. [1],[2]. The case to be presented here had a peculiar presentation and had several treatment and consequences of special interest.


   Case report Top


A 30 years old male reported to a neurosurgeon in Sept. 1987 with the complaints of low back pain followed by paraparesis with hypoaesthesia of both legs and feet with bladder involvement. In Feb 1988 he was treated by laminectomy at L 3 - L 4 level, and excision of peroperatively detected extradural granulamatous mass along with the intervertebral disc between L 4 and L 5 , found to be involved by the mass. Histopathological report suggested that the excised mass was an epidermal cyst of spinal cord. Patient had almost complete neurological recovery and was ambulatory up to 8 years following this operation.

In July 1996, patient came to an orthopaedic surgeon with recurrence of low back pain, paraparesis with another swelling over lumber region with subsequent development of a discharging sinus with liver abscess. Radiologically there was a cystic lesion of L 3 vertebral body with reduction of intervertebral disc space between L 3 and L 4 [Figure 1]. He was treated with anti tuberculous drugs followed by drainage of abscess and excision of sinus tract. The tissues from the back and wall of the sinus were sent for histopathological examination which showed only nonspecific inflammation. Patient was on conservative treatment of caries spine including antitubercular drug for two years with no improvement of neurological status.

In January, 1999 patient attended the Orthopaedic Department of NRS Medical College and Hospital with recurrence of discharge over lumber region with low back pain and persistent paraparesis. Radiologically, there was a persistent cystic lesion of L 3 vertebral body with minimal reduction of height and persistent reduction of disc space between L 3 and L 4 [Figure 2]. Sinogram showed extension of sinus tract up to L 3 vertebral body [Figure 3]. The MRI showed extensive infective changes of lumbosacral spine, a soft tissue mass or epidural mass extending from L 2 to L 4 level. CT guided biopsy suggested tubercular granuloma but no acid fast bacilli were found. He was operated through anterior retroperitoneal approach. On opening the spine, huge amount of thick pus, plenty of membranous flakes extending up to spinal cord were removed in the level of 2nd to 4th lumber vertebrae, which were sent for histopathology and showed the report of hydatid cyst. Post-operatively, the patient was treated by Albendazole 400 mg daily for 3 months, bed rest with spinal orthosis for 6 months followed by gradual mobilization with the help of lumbosacral corset.

At 25 months follow up patient had significant neurological recovery up to Frankel's classification Grade E from pre-operative grade Frankel-C with slight weakness of dorsiflexion of right foot and ankle. Patient is now ambulatory but developed a discharging sinus which again healed with Albendazole 400 mg daily for 6 weeks. Radiologically cystic lesion of L 3 vertebral body is reduced in size with clear margin of demarcation and reactive sclerosis [Figure 4].


   Discussion Top


Primary vertebral involvement of hydatid disease can be diagnosed by clinical suspicion specially when there is close association with the dogs or the patients comes from sheep farmer's community, because the dogs are the primary host and the sheep or men are the secondary host of ecchinococcus. [11] .

In orthopaedic practice, spine is the common site of infection [1],[2],[3],[4],[5],[8] ] though affection of other bones like rib [1] , femur [2],[12] , sacrum [11] , ileum [12] , tibia [12] , humerus [12] are also reported. In the spine the common presentation is low back pain followed by gradual onset compressive myelopathy and paraparesis [3],[4],[7],[8] with or without bladder and bowel involvement. Radiograph suggests cystic destruction of adjacent vertebrae with paravertebral shadow [1],[3] , often unilateral [1] resembling caries spine, However, non response to conservative treatment including antitubercular drug should raise the suspicion and Casoni's test may be performed for supportive test [3] , whereas MRI or CT guided FNAC may be misleading like the presented case. Only histopathological examination of the excised tissue from spine during decompression can clinch the diagnosis. Thorough decompression of the cord including excision of the lesion preventing its spillage into the adjacent soft tissue and post operative prolong use of Albendazole is the mainstay for neurological recovery but total eradication of the disease is very difficult as seen in the present case.

 
   References Top

1.Tuli SM. Tuberculosis of the skeletal system. Second Edition. 2000; 215-216.  Back to cited text no. 1    
2.Srivastava TP, Tuli SM. Hydatidosis of spine and femur: A report of two cases. Ind J Orthop. 1974; 5-7: 86-89.  Back to cited text no. 2    
3.Sami A, Elazhari A, Ouboukhlik A, Elkamar A, Jiddane M, Boucetta M. Hydatidose vertebro-medullaire. Neuro-Chirurgie. 1996; 42 (6): 281-7.  Back to cited text no. 3    
4.Parvaresh M, Moin H, Miles JB. Dumbbell hydatid cyst of the Spine. Br J Neurosurg. 1996; 10(2); 211-3.  Back to cited text no. 4    
5.Gelabert-Gonzalez M. Compression medular por quiste hidatidico ver­tebral, Revista de neurologia. 2000; 30: 654-5.  Back to cited text no. 5    
6.Pamir MN, Akalan N, Ozgen T, Erbengi A. Spinal hydatid cyst. Surg Neurol. 1984; 21 (1) :53-7.  Back to cited text no. 6    
7.Wani MA, Taheri SA, Babu ML, Ahangar GA, Wani H. Primary spinal extradural hydatid cyst. Neurosurg. 1989; 24(4): 631-2.  Back to cited text no. 7    
8.Baysefer A, Gonul E, Canakci Z, Erdogan E, Aydogan N, Kayali H. Hydatid disease of the spine. Spinal Cord. 1996; 34 (5): 297-300.  Back to cited text no. 8    
9.Medjek L, Zenini S, Hammoum S, Hartani M. Hydatidose intra-durale rachidienne dorsale. A propos d'un cas. Ann Radiol. 1991, 34 (4) p251-5.  Back to cited text no. 9    
10.Ruelle A, Boccardo M, Lasio G, Severi P. Idatidosi vertebrale primitiva. Daso clinico e breve revisione della letteratura ; Riv Neurol (Italy). 1985; 55(5):332-7.  Back to cited text no. 10    
11.Solomon L, Warwick D, Nayagam S, Mankin HJ. Graham Apley's Textbook of "System of Orthopaedics and fractures".: 8th Edition. 2001; 48-49.  Back to cited text no. 11    
12.Sapkas GS, Stathakopoulos DP, Babis GC, Tsarouehas JK. Hy­datid disease of bones and joints. 8 cases followed for 4-16 years. Acta Orthop Scand. 1998: 69(1) 89-94.  Back to cited text no. 12    

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Correspondence Address:
A K Pal
1/1a Yogi Para Bye Lane, Kolkata - 700 006
India
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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4]



 

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