Diagnosis and treatment of spinal hydatid disease

English Keywords:Spinal hydatid disease  Echinococcosis disease  Alveolar echinococcosis disease  Diagnosis  Treatment

English Abstract:

  【Abstract】　Objetives: To investigate the diagnosis and treatment of spinal hydatid disease. Methods: 9 cases suffering from spinal hydatid disease treated surgically from October 1990 to October 2010 were reviewed retrospectively. The natural history of spinal hydatid disease ranged from 3 months to 12 years. 9 cases presented with fever, back pain and mass formation. Preoperative Frankel grade showed 1 grade A, 2 grade B, 2 grade C and 4 grade D. Hydatid 8 tests were positive for all cases. The lesion located at thoracic vertebrae in 2(T8, T9 in 1; T11, T12 in 1), lumbar vertebrae in 2(L3 in 1; L1, L2, L3 in 1）, thoracic waist in 4(T12, L1 in 2; T12, L1, L2 in 2），and sacrum in 1. CT images showed bone hydatid similar to tuberculosis in 5 cases, metastases in 2, chordoblastoma in 1, psoas abscess in 1. 7 cases were determined as spinal hydatid disease by MRI, while 2 cases were diagnosed as spinal metastasis due to deficiency of typical findings of MRI. All cases underwent debridement, bony graft or bone cement filling and instrumentation. 2 cases with defect in thoracic and 1 in sacrum underwent posterior decompression and laminectomy. 4 cases with defect in thoracic underwent anterolateral approach. Albendazole was administrated for 2-3 weeks preoperatively and 3 months after operation. Results: The average surgical time was 260min(range, 210-330min), with the average intraoperative blood loss of 300ml(range, 170-470m1). 7 cases determined as spinal hydatid disease by preoperative MRI were diagnosed as spinal echinococcosis disease by pathologic test after operation, and 2 cases similar to spinal metastasis in preoperative MRI were diagnosed as alveolar echinococcosis disease. 9 cases were followed up for an average of 4.6 years(range, 1 to 10 years). 1 case suffering from nonunion and diagnosed as alveolar echinococcosis achieved complete bony fusion at a mean of 1 years by responsive management. 6 cases had Frankel grade improving at final follow-up, while 3 cases remained unchanged. No recurrence was noted in all cases during follow-up. Conclusions: Spinal echinococcosis disease can be determined by MRI, while for lumbar vertebral alveolar echinococcosis disease, MRI is easy to induce misdiagnosis, and its determination is relied on pathology. For the spinal hydatid disease, both drug and Surgery treatment could achieve better results.