ABSTRACT

Hydatid disease is caused by larval form of the flatworms Echinococcus granulosus and Echinococcusmultilocularis. Bone involvement is extremely rare (2%), with vertebral column being infested in half of these cases. Thoracic vertebra is the most affected site.

24 years old female presented with severe back pain exacerbated on walking. Radicular symptoms were absent, there was no incontinence or motor-sensory deficit. She had underwent 2 biopsies at another institution with inconclusive results. CT scans and MRI revealed extradural intraspinal paraspinal hydatid disease at T8-9-10 levels. Patient received 4 courses of Albendazol treatment before surgery. She underwent 2 staged anterior and posterior surgery. Decompression and excision was achieved by laminectomy and 3 level corpectomy. Stabilization was achieved via rodscrew construct and titanium cage.

No complications occurred throughout and after the surgery. Patient was mobilized on the first postoperative day. Her pain eased and she remained symptom free till now. IHA levels remained lower than those of before the surgery.

Spinal hydatid lesion needs to be approached as if a malign tumour. Wide resection with combined anterior and posterior approach is necessary for successful treatment and decompression of vertebral and paraspinal hydatid disease. This is the first case where a multilevel spinal hydatid disease is treated with 3 level corpectomy. Multilevel spinal involvement should not be a reason to avoid surgical treatment if the lesion can be excised with three level corpectomy. Andazol therapy prior to surgery is beneficial in decreasing the viability and size of the cyst.