Surgical Treatment of Spinal Hydatidosis

Abstract

Spinal hydatidosis is a relative infrequent but serious infestation. The disease is generally silent and has a progressive course with a latent period of many years. The infestation erodes the spinal column leading to its destruction. Neurological deterioration occurs when the spinal cord becomes compressed, oedematous or ischaemic due to compression by cysts or vascular compromise. Additionally destruction of the spinal column can cause instability and secondary neurological damage. Surgery is still the most frequently preferred and effective treatment modality for the management of spinal hydatidosis. The posterior approach with simple decompressive laminectomy is the most common performed surgical intervention. Posterior spinal stabilisation may be required when segmental instability or postlaminectomy kyphosis occurs. Radical bone excision by some procedures via transpedicular route is advocated for more extensive lesions with corpus involvement. The anterior approach with corpectomy and anterior stabilisation is an alternative for cases especially with anterior spinal column involvement. Measures should be taken for avoiding cyst rupture and spillage during surgery. This cannot be achieved despite excellent care especially for the lesions involving the bone. Intraoperative prophylaxis with scolicidal agents can be useful for reducing recurrence although the efficacy is not proven. Despite the advances in surgical techniques, the disease still continues to be difficult to cure and is prone to recurrence. The overall prognosis is unfortunately poor. In this chapter the authors review the current surgical management protocols for spinal hydatidosis.