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

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.