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Hydatid cyst of the spine a study of 25 patients

Background: The spine is rarely affected by Hydatid cyst with incidence of (1%) of all cases. Despite
advances in imaging as well as surgical and medical treatment, spine Hydatid cyst (H.C) is associated
with high degree of morbidity, disability, and mortality.
Objective: To assess the clinical presentation, imaging of spine H.C. & the outcome of surgical
management regarding neurological recovery, recurrence and mortality.
Patients and Methods: This is a retrospective study of the 25 patients of spine Hydatid cyst during
five years period (Jan.2010 to Jan.2015), where diagnosed and treated at medical city. All patients
after proper clinical assessment, imaging and laboratory tests had underwent posterior decompression
laminactomy and removal of all Hydatid cyst without spine instrumentation. They received
Elbendazol drugs (antihelmantic drugs) for three months with follow up six months to two years.
Results: They presented with paraplegia in (48%), paraparesis of lower limbs in (32%), local pain and
radiculopathy in (12%) and asymptomatic in (8%). The spinal level was affected by hydatid cyst
lumbar (64%), dorsal (24%), cervical (8%) and sacral (4%). 23 patients posterior decompression
laminectomies were done, 8 patients re-do surgery and 2 patients had evacuation of subcutaneous
multiple Hydatid cyst.Complete neurological recovery was achieved in (100%) of cases after primary
surgery, but recurrence rate was in (21) patients (84%) and worsening of neurological status in two
patients (8%).
Conclusions: Management of Hydatid cyst spine disease is challenging because of high recurrence
rate, requiring aggressive and repeated surgeries with high rate of surgical complications and
significant long term morbidity.Results are not satisfactory and prognosis is poor.

خلفية الموضوع :ان العمود الفقري يصاب بالاكياس المائية بنسبة قليلة جدا (1%), بالرغم من التقدم التقني بالتصوير الشعاعي والعاج الجراحي والعقاقير الطبية لازال المرض ينتج عنه درجة عالية من العوق والمعانات و الوفيات.

الغاية من الدراسة:هو تقيم الاعراض السريرية والفحوصات الشعاعية ونتائج العلاج الجراحي من ناحية حدوث المضاعافات والوفيات وتحسن الحالة العصبية السريرية للمريض.

طرق العمل:دراسه رجعية ومستقبلية تشمل 25 مريض يعاني من الاكياس المائية في العمود الفقري خلال خمسة سنوات في مدينة الطب (2010-2015) بعد اجراء الفحوصات السريرية و الشعاعية الازمة اجريت لجميع المرضى عملية فتح الفقرات من الخلف مع رفع الاكياس المائية وبدون تثبيت الفقرات مع اعطاء علاج البندازول لمدة ثلاثة اشهر مع المتابعة الطبية ولمدة تتراوح من ستة اشهر الى سنتين.

النتائج: الاعراض السريرية كانت شلل الاطراف الكامل بنسبة( 48%) وشلل الاطراف الجزئي(32%) مع الالم الظهر والساق (12%) وبدون اعراض سريرية (8%) ,اجريت 23 عملية فتح الفقرات مع رفع الاكياس المائية والضغط على الاعصاب و الحبل الشوكي مع تحسن واضح وكبير في حركة الاطراف بعد اجراء العملية الاولى , تم اعادة فتح الفقرات مع رفع الاكياس المائية الراجعة مجدد في ثمانية مرضى .

التوصيات: بالرغم من تحسن حالة المريض المصاب بالاكياس المائية في الفقرات بعد اجراء التداخل الجراحي الاولي الا انه لازال العلاج الجراحي معقد وصعب بسبب عودة المرض مرات متعدده وبدرجة عاليه وشديده مع نسبة عالية من المضاعفات والعوق و الوفيات .

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