Surgical management of a recurrent hydatid cyst in the thoracic spine of a postpartum patient with paraplegia: a rare case report and literature review

Abstract

Background: Hydatid disease is a health problem caused by Echinococcus granulosis. Spinal hydatidosis is relatively uncommon when compared to hydatid disease of visceral organs, such as the liver.

Case description: This report details the case of a 26-year-old female who presented acutely with incomplete paraplegia following delivery via cesarean section. She was previously treated for visceral and thoracic spine hydatid cyst disease. On magnetic resonance imaging (MRI), a cystic lesion suggestive of hydatid cyst disease was identified as causing severe cord compression, mainly at T7, raising suspicions of recurrence. Emergency decompression of the thoracic spinal cord via costotransversectomy was performed, as well as the removal of a hydatid cyst and instrumentation from T3-T10. Histopathology findings were consistent with a parasitic infection, specifically Echinococcus granulosis. The patient was administered albendazole for treatment and subsequently had full neurological recovery at the final follow-up.

Conclusions: Diagnosis and treatment of spinal hydatid disease is challenging. Surgical excision of the cyst for neural decompression and pathological identification of the cyst is the initial treatment of choice, alongside albendazole chemotherapy. In this review, we have analyzed spine cases reported in the literature and present the surgical approach applied to our case, which was the first reported case of spine hydatid cyst disease following delivery and recurrence. Uneventful surgery, avoiding cyst rupture, and treatment with antiparasitic medication are the mainstays of spine hydatid cyst management and avoidance of recurrence.

Keywords: Hydatid cyst; case report; paraplegia; postpartum cyst; thoracic spine cyst.

Figure 1

T2-weighted midline sagittal (left) and axial (right) thoracic spine MRI (A) and T2-weighted left sagittal (left) with corresponding axial (right). Thoracic spine MRI of the level of T7 vertebral body (B). (A) Demonstrating a multiloculated septated and thin peripheral enhancing cystic lesion measuring approximately (4×2.7×2.6 centimeters) located at T7; extradural involvement of the posterior part of T7 vertebral body and bilateral pedicles causing spinal cord compression and high signal intensity that represents cord compression (myelomalacia) can be seen with bilateral neural foraminal and left paravertebral extension. Green line in (A) represents the exact location of the shown axial view in the sagittal plane. MRI, magnetic resonance imaging.

Figure 2

Central sagittal (left) and axial (right) spine CT (A), and left sagittal spine (left) and axial spine (right) CT of the corresponding level of T6, T7 vertebral body (B). (A) Showcasing a left paraspinal multilocular complex cystic lesion at T6 and T7 vertebrae extending into the spinal canal with significant spinal cord compression; and there is concomitant bone erosion involving T6-T7 ribs with an expansion of T6-T7 left neural foramina, concerning a mediastinal cyst. The CT also revealed the previous laminectomy. CT, computerized tomography.

Figure 3

Postoperative lateral thoracic spine X-ray demonstrating final fixation from T3-T10 screws (A); and AP spine X-ray of the corresponding levels (B). L indicates the left side. S indicates that there was an external metal. AP, anteroposterior.

Figure 4

AP thoracic spine X-ray image demonstrating the final fixation using T3-T10 screws at 6 months follow up (A), and lateral spine X-ray image showing the corresponding levels at 6 months follow up (B). AP, anteroposterior.