Neurochirurgia 20 (1977), 211-21.5 © Georg Thieme Verlag Stuttgart

Hydatid Disease of the Spine A. A. Morshed Dept. of Neurosurg., Pahlavi School of Medicine, University of Teheran

Summary

The site of the hydatid lesion in these patients was as follows:

In 42 cases of hydatid diasease of the spine the preoperative diagnosis was as follows: hydatid disease benign tumour Tuberculosis malignant disease herniated disk syringomyelia infectious spondylitis

14"

19 S 6 4 3 1 j

cervical thoracic (T6-T12) lumbosacral

5 26 11

Seven of these cases had previously been operated on for a hydatid cyst in other organs. We had eight recurrences of which five did not respond completely to surgical intervention. Keywords: spinal cyst - hydatid cyst - myelography

Heruntergeladen von: Universite de Sherbrooke. Urheberrechtlich geschützt.

CASE REPORT - FALLBERICHT

A. A. Morshed

Zusammenfassung

Table I: Statistics collected from Teheran University Hospitals are as follows:

In 42 Fällen von Hydatidosis der Wirbelsäule war die präoperative Diagnose wie folgt: Hydatidosis gutartiger Tumor Tuberkulose maligne Erkrankung Bandscheibenvorfall Syringomyelic infektiöse Spondylitis

19 8 6 4 3 1 1

Univ. Hospital

Date

Surgical cases

Hydatid cysts

Spine

Sina

1964

1400

23

2

Sina

1966

2050

22

1

Pahlavi

1969

2650

25

2

Pahlavi

1973

3423

34

3

Die Lage der Zysten gliedert sich bei diesen Patienten wie folgt: cervical thoracal (T6-T12) lumbosacral

5 26 11

In 7 Fällen war eine Zystenoperation in anderen Organen vorausgegangen. Wir hatten 8 Rezidive, von denen 5 jedoch nicht völlig auf den chirurgischen Eingriff ansprachen.

Introduction In 1807 Ckaussier (1.) first described hydatidosis of the spine. Subsequently there have been several publications referring to this theme. Deve (5, 6) Dèvè and Griesel (7) were the most important authors. Barnet (4) presented in 1934 under the supervision of the Royal College of Surgeons of Australia, a collection of all hydatid cases in Australia and New Zealand. Among 1874 cases he found 2-4% occuring in bones and 50% of this number in the spine. Dèvè's (5, 6) results were almost the same, when in 1948 he reported 638 cases of hydatid cyst occuring in bones, 44% of which were located in the spine. There were also differing results for example given by Ivanissevich (8) who reported 81 cases located in bones, of which 20 occured in the spine (24-5%) and by Azizi (1, 2, 3) in Iran who described 1000 cases, of which 19 were in bones 1-9%, 13 in the spine 68-4%. Also Samiy (9) in 1963 described 40 cases, of which 32 were cranial and intracranial 8 were located in the spine.

Radiological signs We have analysed the X-rays of 42 patients during the last 12 years. These showed positive signs of hydatid disease of spine and destruction of the vertebral body usually confined to one, rarely, to two or more vertebrae. Involvement of the intervertebral disk and vertebral cartilage only take place in the advanced stage. The appearance of one or more lucent areas in the vertebral body is more prevalent. Destruction of the head of the rib next to an involved vertebral body is usually seen with a palpable swelling in this area. According to our experience articular surfaces and intervertebral disks are resistant to the cyst. Only in untreated and advanced cases the articular surfaces and disks may be destroyed.

Results and Discussion With the improvement of health and sanitation in Iran hydatid cysts of bone occur less frequently. Statistics collected from Teheran Hospitals between 1965 and 1975 support this argument. With better medical facilities and improved hygienic education fewer and less advanced cases are encountered. While during the preceding decade our patients showed more numerous and advanced neurological signs, the main symptoms now are backache and scia-

Heruntergeladen von: Universite de Sherbrooke. Urheberrechtlich geschützt.

212

Table II Year:

1965

1966

1967

1968

1969

1970

No.

7

6

6

3

5

4

Year:

1971

1972

1973

1974 1975

No.

3

2

3

2

1

tica. We have found hydatid disease to be more prevalent in the thoracic area compared to the lumbosacral and cervical regions. Before spreading to other regions the vertebral body and the posterior arch are involved. In the body a round or oval filling defect appears with erosion of the cortex, while in most cases the configuration of the vertebra remains intact. One of the characteristic signs of hydatid

213

cyst is the calcification in its wall which makes it appear as a round ring (Fig. 1). There were 23 cases without any change in the exterior shape of the vertebral body; 5 of them were diagnosed by AP films, 18 by tomography. The filling defects varied in size. In advanced cases the body collapsed and was wedge-shaped (Figs. 2 and 3). In eight of our patients destruction of the vertebral body was seen. Six showed involvement of one, one showed involvement of two vertebral bodies without spreading out on the intervertebral disks and articular surfaces, the eighth patient showed advanced disease which progressed to complete paraplegia; three vertebral bodies with their intervertebral disks were affected. By tomography we could demonstrate in 6 of our patients involvement of the posterior arch - lamina, pedicle and spinous process - the lesions were more or less complete. Rib lesions frequently occur in the head, neck and proximal portion; radiologically the appearence is similar to that in the vertebra. i. e. round or oval cystic masses (Fig. 4). In

Fig.l

Fig. 2

Heruntergeladen von: Universite de Sherbrooke. Urheberrechtlich geschützt.

Hydatid Disease of the Spine

A. A. Morsbed

most cases the transverse process of the adjoining vertebra is involved. We saw these rib lesions in nine of our patients. Radiologically the periosteum appeared separated and there were multiple cystic lesions. In some cases these cysts extended into the extradural space. The affected rib was always removed. Whenever the hydatid cyst is located in a thoracic vertebra, it is always necessary to search for the adjoining rib, which in the majority of cases is involved. In advanced cases, if more than one vertebra is affected, the cartilaginous surface and the intervertebral disk are destroyed. One per cent of our patients presented this condition. In the thoracic region X-ray shows a triangular paravertebral shadow with its base attached to the vertebral column, it is usually calcified (Dévé) (5, 6) (Fig. 5). In the lumbar part of the spine the cysts may penetrate under the psoas fascia. Radiologically

Heruntergeladen von: Universite de Sherbrooke. Urheberrechtlich geschützt.

214

215

we found a polycystic appearance in the paravertebral area (one personal case). We see the hydatid cyst occurring as a tumour in the sacral region (Fig. 6). If it affects the cervical spine it often appears in the supraclavicular area. Out of 11 cases of thoracic hydatid disease nine were pre-operatively diagnosed; in the remaining two patients we suspected spinal tuberculosis. In four of these cases the adjacent rib was also affected. In three of our cases the cysts were located in the psoas muscle, and in two cases they had occupied the pelvic region and destroyed the ileum and sacrum.

Ancillary

investigations

As to haematological findings particular attention should be paid to eosinophilia. In every case an intradermal Casoni test must be done. A complete history of the patient particularly referring to hydatid cyst in the past is most important. Simple X-ray, tomogram, myelogram and in uncertain cases ar-

Fig. 6 renography belong to the diagnostic steps. If there is no sign of malignancy in the arteriogram, hydatid disease must be considered. Abnormality in the distribution of blood vessels may indicate the site of the cysts.

References 1

2 3

4

Azizi, D.: Endemiologie du kyste hydatique en Iran, Experience basée sur l'activité de h ô p i t a u x de Tehran-Iran. Tehran Revue de med. Orient 3 (1963) 211 Azizi, D . : Endemiologie du kyste hydatique en Iran. Presse méd. 71 (1963) 2076 Azizi, D.: A propos des kystes hydatiques opérés a Tehran-Iran. Journal of the iranian medical council 2 (1973) 127 Barnet, h.: Report to Royal college of surgeons of Australia and N e w Zealand. Ausr. and N . Z. Journal of surgery 12 (1943) 240 A. A. Morshed,

M. D., Assistant

5

Dévé, F.: L'echinococcose osseuse Montevideo. Monterederc ad. Co. 1948 236 p p . (see p p . 30-44 and 67-68) 6 Dévé, F.: L'echinococcose osseuse. Paris - Masson edit. 1948, Vol. 1. 7 Dévé, F., P. Griesel: L'echinoeocose vertebral chir. Paris 48 (1929) 375-394 8 Ivanissevicb, O., C. Rivas: Equinococcosis htdatidica. Buenos Aires Amorrota 1962, Vol. 2. 9 Samii, E-: Kompression des Rückenmarks und der Cauda equina durch Echinokokkuszysten. Acta Neurochirurgia 11 (1963) 369-384

Prof, of Neurosurgical

Dept.,

Pablavi School

of Medicine,

University

of

Teheran

Heruntergeladen von: Universite de Sherbrooke. Urheberrechtlich geschützt.

Hydatid Disease of the Spine

Hydatid disease of the spine.

Neurochirurgia 20 (1977), 211-21.5 © Georg Thieme Verlag Stuttgart Hydatid Disease of the Spine A. A. Morshed Dept. of Neurosurg., Pahlavi School of...
1MB Sizes 0 Downloads 0 Views