Case 269: Sacroiliac Joint Hydatid Disease.

HistoryA 20-year old woman living in Turkey presented with a 3-month history of lower back pain. She had no medical history of note and was taking no medications. Complete blood count, C-reactive protein level, sedimentation rate, and creatinine, alanine aminotransferase, and aspartate aminotransferase levels were within normal limits. Anteroposterior pelvic radiography and unenhanced pelvic CT were performed to rule out sacroiliitis. The imaging findings were abnormal, and the patient underwent contrast-enhanced sacroiliac MRI. A few days later, she underwent contrast-enhanced (100 mL iohexol, Omnipaque; GE Healthcare, Cork, Ireland) abdominal CT because of right upper quadrant pain.

A man with disabling low back pain: Echinococcus of the sacrum.

Bone involvement in hydatid disease is rare, and when it does occur, the most common sites of involvement are the spine and pelvis. A case of bone hydatid disease involving the sacrum is reported here.

Hidatidosis vertebral: a propósito de un caso / Vertebral hydatidosis: case report

La hidatidosis causada por el echinococcus granulosus puede afectar cualquier órgano del cuerpo siendo el pulmón y el hígado los más comúnmente afectados. El compromiso vertebral por el echinococcus granulosus es de escasa prevalencia, comprendiendo con menos de 1% del compromiso óseo. Presentamos el caso de una mujer de 50 años que consultó en Servicio de Traumatología por cuadro de dolor lumbar progresivo, de cinco meses de evolución, irradiado a extremidad inferior derecha y posterior compromiso neurológico de extremidad. El estudio imagenológico reveló espondilodiscitis T12-L1 que posterior a estudio de biopsia confirmó este cuadro. El tratamiento es mixto, tanto ortopédico como quirúrgico. El nivel de recurrencia es alto, reportándose entre 30 y 40%. El objetivo de este caso es proponer diagnóstico diferencial de masa vertebral de origen desconocido y detallar el manejo de esta patología.

Hydatidosis caused by echinococcus granulosus may affect any organ in the body, with the lungs and the liver as the most commonly affected organs. Vertebral compromise resulting from echinococcus granulosus has a low prevalence and accounts for less than 1% of bone compromise. We report the case of a 50 year-old female who presented at the Trauma Service with progressive low back pain with 5 months of duration that irradiated to the right lower limb, and led to neurologic compromise of the limb. Imaging studies showed spondylodiscitis at T12-L1, confirmed by a biopsy. Treatment of this condition is both orthopedic and surgical. The recurrence rate is high, between 30 and 40%. The objective of describing this case is to propose the differential diagnosis of a vertebral mass of unknown origin and provide details as to how to manage this condition.

Influence of Knee Pain and Low Back Pain on the Quality of Life in Adults Older Than 50 Years of Age.

OBJECTIVES: To investigate the impact of knee pain and low back pain (LBP) on quality of life (QoL) in people ≥50 years of age. DESIGN: Cross-sectional study. SETTING: A nationwide survey. PARTICIPANTS: A total of 1295 men and 1658 women aged ≥50 years from the Fifth Korea National Health and Nutrition Examination Survey, conducted in 2010. METHODS: Knee pain and LBP were assessed by a questionnaire, and QoL was assessed by the EuroQol (EQ)-5D, consisting of the EQ-5D descriptive system and the EuroQol visual analogue scale (EQ-VAS). Multiple linear regression models were used to evaluate associations between knee pain or LBP and the EQ-5D index or EQ-VAS score. MAIN OUTCOME MEASUREMENTS: Standardized coefficient (ß) for QoL according to the presence of knee pain or LBP. RESULTS: Both men and women with knee pain or LBP had a lower QoL than those without them in all dimensions of the EQ-5D, EQ-5D index, and EQ-VAS scores. Compared with most other chronic diseases, knee pain and LBP showed stronger negative correlations with the EQ-5D index and EQ-VAS score. In men, LBP showed a stronger negative correlation with the EQ-VAS score than knee pain. The relative impact of LBP on knee pain was greater in people aged ≥65 years than in people aged 50-64 years, especially men. CONCLUSIONS: These results suggest that knee pain and LBP are important factors affecting QoL in middle-aged and elderly people and that LBP may be relatively more important than knee pain in elderly people, especially men. Proper management and prevention of these conditions can help to improve QoL.

[Vertebral hydatidosis: case report]. / Hidatidosis vertebral: a propósito de un caso.

Hydatidosis caused by echinococcus granulosus may affect any organ in the body, with the lungs and the liver as the most commonly affected organs. Vertebral compromise resulting from echinococcus granulosus has a low prevalence and accounts for less than 1% of bone compromise. We report the case of a 50 year-old female who presented at the Trauma Service with progressive low back pain with 5 months of duration that irradiated to the right lower limb, and led to neurologic compromise of the limb. Imaging studies showed spondylodiscitis at T12-L1, confirmed by a biopsy. Treatment of this condition is both orthopedic and surgical. The recurrence rate is high, between 30 and 40%. The objective of describing this case is to propose the differential diagnosis of a vertebral mass of unknown origin and provide details as to how to manage this condition.

Disseminated cysticercosis incidentally diagnosed in a patient of low backache: a case report and concise review of literature.

Disseminated cysticercosis is an uncommon presentation of a common disease. Asymptomatic disseminated cysticercosis is rarely reported in literature. Here, we are reporting a case of asymptomatic disseminated cysticercosis incidentally diagnosed in a patient of low backache. Magnetic resonance imaging of lumbosacral spine and neuroimaging done subsequently during the course of evaluation revealed diffuse cysticercosis involving abdominal, paraspinal, pelvic and gluteal muscles along with neurocysticercosis. Such a disseminated cysticercosis was diagnosed incidentally in this patient of low backache with right sciatica and radiculopathy at L5-S1 prolapsed intervertebral disc and was subsequently managed by L5-S1 interlaminar fenestration and discectomy.

Hydatid cysts in uncommon locations in the same patient: simultaneous cardiac and spinal involvement.

INTRODUCTION: The spine and cardiac cavities are uncommon locations for hydatid disease. Spinal and cardiac hydatid cases separately constitute only 0.5-1% of all hydatid cases. We reported a case with spinal and cardiac involvement simultaneously. Clinical and radiological findings of this unique case are discussed. CASE REPORT: A thirty-four-year-old male patient was admitted to hospital with pain at the low back and left thigh. He had undergone surgery for lumbosacral hydatidosis twice before. Cysts had been removed totally in the last operation. The disease relapsed with widespread involvement of the sacropelvic region. During the investigation, we diagnosed a cyst in the cardiac cavity, incidentally. The cyst in the cardiac cavity was removed totally. DISCUSSION: Hydatid disease is still an endemic disease in South America and some Mediterranean countries including Turkey. Cysts rarely involve the spine and cardiac cavities. The simultaneous involvement of the sacropelvic region and the cardiac cavity is an extremely rare condition. Cardiac cysts have a poor prognosis. Prompt surgical extraction of the cyst is a critical mainstay of the management.

Cauda equina syndrome caused by primary lumbosacral and pelvic hydatid cyst: a case report.

INTRODUCTION: Hydatid disease occurs in humans as a result of faeco-oral contamination and spinal echinococcosis is rare even in areas where echinococcosis is endemic. Hydatid cyst primarily occurs in the liver and lungs. Bone involvement constitutes only 0.5-2% of all hydatidoses. About half of the bone involvement occurs in vertebrae. The thoracic spine is the most common site of the spinal hydatidosis. Primary hydatid cysts of the lumbar and sacral spinal canal are very rare. CASE REPORT: We present a 31-year-old man with cauda equina syndrome caused by a primary hydatid cyst of the lumbosacral and pelvic areas. He had been admitted to hospital with left foot and low back pain three years ago. Magnetic resonance imaging revealed an intraspinal hydatid cyst extending from L2 to S2. The cyst had been totally removed. He was symptom-free for three years. After three years, he presented with acute cauda equina syndrome. His neurological examination revealed total plegia of dorsal flexion of the left foot and perianal hypoaesthesia. MRI showed lumbosacral and pelvic hydatidosis again. After total removal of the cyst, his neurological status revealed immediately relief. DISCUSSION: Hydatid cyst is an important health problem in some countries including Turkey. Bone involvement is seen in only 0.5-2% of cases. Furthermore sacral and lumber vertebral involvement is extremely rare. We presented a case with a spinal hydatid cyst which classified as a combination of intraspinal extradural, vertebral and paravertebral forms according to the Braitwate and Lees classification. Surgical excision and additional medical treatment is still the most effective treatment. Cysts located intraspinally have a tendency to rupture spontaneously. For this reason the high recurrence rate (30- 40%) is still a major problem in management.

Primary sacral hydatid cyst. A case report.

This case report highlights an unusual osseous spinal presentation of a well described disease, hydatidosis. A 59-year-old woman presented with increasing back pain and bilateral radiculopathy. Examination disclosed symptoms of spinal stenosis and urinary incontinence. Radiographs showed an expansive lytic lesion affecting the pelvic bones with destruction of the bone cortex. Laboratory analyses were performed and the patient underwent CT and MRI studies. Serology for Echinococcus was positive. When assessing sciatica, low back pain or lower limb weakness the pelvic cavity should be examined for hidden disease that might explain the neurological symptoms. Hydatid disease of bone should be considered in the differential diagnosis of any bone mass discovered in the human body. Diagnosis was delayed in this case because the pelvic cavity was not studied when radiculopathy symptoms started and there was no coexisting visceral involvement.

[Occupational aspects of low back pain].

Low back pain is a very common ailment among workers of all ages. Approximately 60-90% of the adult population suffers from low back pain at least once during their life time. The yearly incident rate of low back pain is about 1-2%. This is one of the major causes of occupational illnesses and absence from work. A high rate of low back pain is found among workers involved with heavy physical labour and also among truck drivers. Risk factors for low back pain are intense heavy labour, lifting heavy objects, protracted static positions, repetitive movements and awkward body postures accompanied by vibration. Prolonged standing and sitting are not risk factors for low back pain. Work dissatisfaction, low wages and low levels of education are possible predictors for low back pain. The only reliable predictor of future low back pain is the evidence of previous back pain as disclosed during the preemployment health examination.