HIDATID-DISEASE OF THE SPINE AND MEDULLA - A STUDY OF 24 CASES

In this retrospective study, we report our experience of severe hydati d disease located to the spine and the adjacent spinal cord observed i n 24 cases between 1970 and 1994. In our series the sex ratio was pred ominant for males, and the mean age was 29 years. Clinically, the pati ents presented predominantly with a motor deficit. The diagnosis was a ssessed on radiological and biological investigations and was confirme d preoperatively. Hydatid serology was positive in 7 out of the ten ca ses explored: On standard X rays, the bone lesions were frequent: lysi s in 10 cases, vertebral deformation in 3 cases, costal invasion in 5 cases, and paravertebral collection in 2 cases. These lesions were pre dominantly located at the thoracic level. Myelography confirmed a comp lete blockade in X out of 11 cases. When possible, the CT scan confirm ed the bone lesion in all of the 10 cases explored, with an intratheca l cyst in 7 cases and a paravertebral collection in 8 cases. Magnetic resonance imaging was possible in one case only. Medical antihelminthi c treatment was indicated as the sole treatement in one unoperable cas e. All the other patients were operated on, and the adjunctive specifi c medical treatement was associated in 5 cases. Using a posterior appr oach in 20 cases, the operative technique consisted in a complete remo val (if possible) of the invaded bone and soft tissue, thus achieving a complete relief of the spinal cord compression. Complementary bone f ixation was indicated in 2 cases. During the postoperative follow-up, two patients died from infection and trophic ulceration, 11 patients i mproved and 8 patients remained unchanged. In 5 cases, a reoperation w as indicated and performed from 2 to 4 times. Three patients were lost for follow-up. The severity of this affection is confirmed in the lit erature. A complete recovery is quite exceptional. The best treatment remains an active nationwide prevention of the disease.