Background: Hydatid disease, or cystic echinococcosis, is a zoonotic parasitic infection caused by the larval stage of Echinococcus granulosus. The liver and lungs are the most frequent sites of involvement, whereas osseous localization is uncommon. Among skeletal forms, vertebral hydatidosis is one of the most severe because of its infiltrative behavior, destructive bone involvement, high recurrence risk, and potential for irreversible neurological impairment.

Case Presentation: We report the case of a 46-year-old man from western Morocco with recurrent disseminated hydatid disease involving the lungs, liver, and spine. Over a 20-year period, he underwent multiple surgical procedures for recurrent hepatic, pulmonary, and vertebral hydatid cysts. He presented with progressive bilateral lumbosciatica, severe gait limitation, spastic paraparesis, pyramidal signs, sensory loss below the umbilicus, and sphincter dysfunction, consistent with chronic compressive myelopathy.

Imaging and Management: Spinal MRI showed multiloculated daughter cysts extending from T9 to T12, with paravertebral, epidural, and intraspinal involvement causing spinal cord compression. Axial sequences demonstrated a paravertebral hydatid abscess with posterior soft-tissue extension and fistulization toward the skin surface. CT showed vertebral lysis, postoperative instability, and mechanical failure of the osteosynthesis construct. Surgical decompression was performed with evacuation of the paravertebral abscess, removal of daughter cysts, debridement of involved tissues, and extraction of the broken osteosynthesis material.

Outcome: At three months after surgery, the neurological status remained essentially unchanged, with persistent spasticity, severe residual sensorimotor deficit, and marked functional limitation.

Conclusion: Recurrent vertebral hydatidosis should be regarded as a chronic, locally aggressive, destructive spinal disease with tumor-like behavior. Early recognition of recurrence, maximal safe decompression, prevention of intraoperative disse- mination, stabilization when required, and prolonged radiological surveillance are essential to preserve neurological function.