Total en bloc spondylectomy with artificial vertebral body replacement for thoracic spinal hydatidosis with hepatic involvement: a case report and literature review.

Abstract

Objective: To report a rare case of thoracic spinal hydatid disease with concomitant hepatic involvement successfully treated by total en bloc spondylectomy (TES) and vertebral body reconstruction. This report focuses on the surgical decision-making process for a neurologically intact patient with extensive disease and provides a detailed technical description of the procedure, including the use of a single-stage, posterior-only approach.

Case presentation: A 63-year-old female with a history of sheep farming presented with a 20-day history of low back pain. Imaging revealed a destructive lesion at T12 with paravertebral extension and a complex cystic lesion in the right hepatic lobe. Serology was positive for hydatid IgG. Despite the absence of neurological deficits, the extent of vertebral destruction indicated a high risk of instability and neurological compromise. Following a multidisciplinary discussion, the patient underwent posterior TES of T12 with partial rib resection, en bloc excision of the involved psoas muscle segment, artificial vertebral body replacement, and posterior instrumentation.

Results: The surgery was completed in 250 min with 600 ml blood loss. Postoperative recovery was complicated by pulmonary atelectasis, hypoalbuminemia, and deep vein thrombosis, which were successfully managed. Pathological examination confirmed hydatid disease. At the 3-month follow-up, the patient remained neurologically intact with no signs of recurrence on imaging, demonstrating excellent short-term local control.

Conclusions: This case underscores that TES is a viable and effective option for achieving short-term local control in spinal hydatidosis, even in patients without neurological compromise, provided there is a high risk of instability. The decision for radical resection should be based on a comprehensive assessment of disease extent, patient fitness, and the potential for complete excision. However, long-term follow-up is crucial to monitor for late recurrence, and the omission of adjuvant albendazole in this case highlights a critical area for improvement in perioperative management.