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Spine

In the spine, the dorsal vertebrae are the most frequently affected with hydatid disease, especially the lower six thoracic vertebrae; over half of the cases with vertebral involvement occur in this area. About 30% of patients with vertebral hydatidosis will develop epidural extension of their disease with resultant compression of the spinal cord and paraplegia. There is usually pain and perhaps local swelling over the area. The pain and paraplegia occurs quite acutely. In the past, treatment has generally been unsatisfactory and, even in the unusual case where surgical resection appeared possible, recurrence was usually inevitable. Wounds failed to heal, sinuses developed, and continuing paraplegia and chronic invalidism were the end result (Fig. 3.139). Chemotherapy is helpful in many such cases today.

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Fig. 3.139 Hydatid disease of the spine in a cachectic 53-year-old Italian man, who 10 years earlier was found to have hydatid cysts in the spine during a laminectomy to decompress his spinal cord. Dissemination to the pleura, lungs and flank followed. The patient died several months after these photos were made. (A) There is a prominent kyphosis due to compression of vertebral bodies eroded by the cysts. Also note the bulge of the left flank caused by an underlying hydatid. (B) Posterior view showing scars from previous surgery, the large hydatid cyst bulging the left flank, and several smaller cysts near the upper end of the old midline surgical incision. (C) Incision into one of the hydatid cysts permitted escape of pseudopurulent material.

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