In hydatid of the spine, there is not one cyst around which dissection can be carried out. The bone is infiltrated with a great number of minute cysts. In cases where leaked fluid containing parasites is left behind at the surgical site, concerns are raised about delay of skin closure, leading to deep pyogenic infection. It is particularly a cause of concern when surgical intervention is complicated by cerebrospinal fluid leakage. In this case, lumbar drainage may be required. Intensive muscle closure is also required during surgery to avoid fluid leakage. A plastic surgical procedure, such as musculocutaneous flap transfer, is often required for chronic infection. Although there have been few reports about larger series of spinal hydatidosis, Herrera et al. (2005) reported that 50 % of recurrence cases also have chronic wound infection with chronic productive sinuses that required several surgical debridements. Because surgery for spinal hydatidosis is extensive and the reappearance of postoperative surgical wound infection is frequent, perioperative antibiotic therapy is important.

Another surgery-related complication is allergic reaction caused by rupture of the cyst. This reaction ranges from mild hypersensitivity to fatal anaphylaxis (Kök et al. 1993; Wellhoener et al. 2000; Laifer et al. 2002). Because spinal hydatidosis is usually advanced, rupture of the cyst into the surrounding tissue will already have occurred and the possibility of serious allergy manifesting during surgery is regarded as extremely low. However, this possibility makes close monitoring mandatory during surgery, with facilities available for treating potential complications, particularly anaphylactic shock and laryngeal edema (Khuroo et al. 1997).

Recurrence remains a major problem in spinal hydatidosis (Figs. 18.7, 18.8, 18.9, and 18.10); the literature cites a rate of 30–100 % (Schnepper and Johnson 2004). The thin wall may easily rupture, either spontaneously or due to surgery, resulting in recurrence of multiple cysts (Schnepper and Johnson 2004). It is extremely difficult to resect the extradural lesions involving the spine without rupturing the hydatid cyst because the cysts are contained in narrow spaces within bone boundaries (Schnepper and Johnson 2004; Tabak et al. 2007). Therefore, the management of echinococcal cysts usually involves a combination of surgical resection and antihelminthic therapy.