Primary hydatid disease of the spine: an unusual cause of progressive paraplegia. Case report and review of the literature

Abstract

Although rare, spinal hydatid disease is a manifestation of hydatid infestation. The authors present the report of a patient who presented with primary spinal hydatid disease. This disease is often misdiagnosed as tuberculous spondylitis, and thus patients may subsequently receive inappropriate treatment. The patient in this case presented, with an increasing weakness in the lower limbs, to a different clinic from an area in India where hydatid infections are endemic. The infection was misdiagnosed as tuberculous spondolytis based on evaluation of plain x-ray films, and the patient underwent antituberculous chemotherapy and a posterior surgical decompressive procedure. The patient presented to the authors' clinic with increasing paraparesis 1.5 years later. Radiographs and a magnetic resonance image of the spine were obtained, which strongly suggested hydatid disease. Examination of serum levels confirmed the diagnosis. The patient underwent a decompressive procedure of the spine in which stabilization was performed. Postoperatively her paraparesis resolved, and good control over the disease was achieved by chemotherapy. The authors conclude that primary spinal hydatid disease of the spine, although a rare manifestation, should be considered in the differential diagnosis in patients with infectious and destructive lesions of the spine in regions in which the disease is endemic. Advanced imaging studies should be performed to diagnose the disease. Early decompressive surgery with stabilization of the spine, in addition to adjuvant chemotherapy, is the treatment of choice for these patients.