Paleopathologies of the vertebral column in medieval skeletons

Paleopathological data provide valuable information about health, longevity and mortality in earlier human populations. We investigated the incidence of spinal pathologies on 54 individuals (1045 vertebrae and 18 sacral bones) that belong to a medieval skeletal series discovered in the Dalheim monastery (Northwest Germany) and compared them with contemporary and recent populations. The skeletons were analyzed with anthropological methods (sex and age determination), by macroscopic inspection, and, if pathologies of the spine and the sacrum were visible, also by X-ray. We investigated evidence of trauma, specific and nonspecific infectious diseases, joint diseases, tumors, and congenital as well as metabolic disorders. Radiocarbon determination of four samples of different specimens was also undertaken revealing a historic dating of ca. 1050 AD. The most common pathological findings were degenerative changes of the spine found in 29 individuals (53.3%). Examples of infections of the spine were rare (0.8% of all vertebrae). There were no cases of traumatic injuries of the spine. The prevalence of spondylosis deformans, the most commonly found type of pathology was found to be higher in the lumbar region, in males as well as in individuals of low stature.

Barré-Lieou syndrome and the problem of the obsolete eponym

BACKGROUND

Eponym lists in major sources can give an aura of legitimacy to discredited diagnoses, as exemplified by the case of Barré-Lieou syndrome, a 'rare' vestibular disorder.

METHODS

A literature review for information on the posterior cervical syndrome of Barré-Lieou.

RESULTS

Barré-Lieou syndrome includes very common symptoms--tinnitus, dizziness, and head or neck pain--attributed to ischaemia caused by cervical sympathetic nerve compression. Its original description brings together many unrelated disorders, and its causative mechanism has been discredited. However, it appears credulously in a number of eponym lists, and references to the syndrome are steadily increasing on the internet in general and on alternative medicine and legal profession websites in particular.

CONCLUSION

By inclusion in eponym lists, without a disclaimer, a syndrome can be given legitimacy before the general public. A syndrome, such as Barré-Lieou syndrome, that is useless to the medical profession can unfortunately prove to be very useful for litigants and disability claimants.

Lumbar Spine Fracture in a 34,100-year-old Skeleton: The Oldest Known Prehistoric Spine Fracture

WE EXAMINED SPECIAL pathological changes of the lumbar spine from skeleton remains referred to as "Stetten 1," one of the earliest specimens of modern humans dating from the Early Stone Age (Upper Paleolithic). The skeleton was discovered during archaeological excavations under Riek in 1931 in the Vogelherd Cave near Stetten, close to the Lone Valley of southwestern Germany. The archaeological context is the so-called Aurignacian period (40,000-30,000 yr ago), representing the earliest cultural step of modern humans in Europe. Accelerator mass spectrometry with (14)C measurement yields a calibrated age of these remains averaging 34,100 years before the present. The L3-L4 vertebrae exhibit marginal bone fusion on the right side with a smooth surface. They show 20- to 30-degree kyphosis secondary to wedge impaction of the L4 vertebral body. The facet joints and vertebral bodies reveal small marginal osteophytes with even joint surfaces, indicating low degenerative changes. Stetten 1 is characterized by the presence of a healed lumbar spine fracture. It documents the earliest known case thus far of spine fracture among modern humans.

[Goethe's skull and skeleton]

In 1970 there was a conservation of Goethe's skeleton, housed in the Fürstengruft in Weimar. This procedure was kept secret until 1999. The restoration of the sarcophagus and the conservation of the skeleton have been documented together with many photos in the so-called "Sonderakte Mazeration Goethe" (special file mazeration Goethe). In this special file there are also photos of Goethe's skull and skeleton which will be published here for the first time and analysed under anthropological and palaeopathological aspects. A short description of the skull will be given. The dentition of Goethe at the time of his death and the question of progenia in Goethe's family are discussed in detail. Data on Goethe's stature obtained from the skeleton qualify statements of Goethe's contemporaries. Among the few documented pathological changes the ankylosis of eight thoracal vertebrae (T 5-12) and five right ribs are of special interest, caused by the loss of the intervertebral discs, spondylosis deformans and Morbus Forestier. A connection between this ankylosis and the known stiff posture and stiff gait of Goethe is obviously and possibly dates back to Goethe's fortieth years of age.

Spondyloarthropathy identified as the etiology of Nubian erosive arthritis

Slight variation in manifestation of different diseases may allow a single individual with one disease to mimic the "classic" appearance of another, as evidenced by the frequent confusion of spondyloarthropathy with rheumatoid arthritis. Analysis of population occurrence of arthritis (rather than isolated skeletons) facilitates more precise diagnosis. Northeast Africans living around 2,000 years before present were clearly afflicted with a form of spondyloarthropathy. Lack of inclusion of spondyloarthropathy in the differential diagnosis of erosive arthritis led to past misclassification of Nubians as having rheumatoid arthritis. While evidence of spondyloarthropathy abounds in the literature of human skeletal disease, pre-Columbian Old World rheumatoid arthritis is still elusive. The current study further documents the absence of rheumatoid arthritis in Nubians, supporting the hypothesis that rheumatoid arthritis began in the New World.

Spondylolysis and its relationship to degenerative joint disease in the prehistoric southeastern United States

Spondylolysis, a fatigue fracture in the neural arch of lumbar vertebrae, is common in Eskimos and some athletes. In Archaic Indians from northwestern Alabama, 17% of males and 20% of females with complete lumbar regions showed this defect. It is found at a fairly early age in adult males in this group, but in females it does not appear until after age 40 years. Spondylolysis is associated with higher levels of osteoarthritis around the fifth lumbar vertebra, where this defect typically occurs. Otherwise, there is little relationship between its presence and degenerative joint disease, especially in the weight-bearing joints. The incidence in young males may be related to activities necessitating a high level of mobility around the lumbar spine. The late occurrence in females suggests that osteoporosis may have been a contributing factor.

The pathogenesis of cervical spondylosis

Cervical spondylosis is a generalized disease process affecting all levels of the cervical spine. Cervical spondylosis encompasses a sequence of degenerative changes in the intervertebral discs, osteophytosis of the vertebral bodies, hypertrophy of the facets and laminal arches, and ligamentous and segmental instability. The natural history of cervical spondylosis is associated with the aging process. Senescent and pathologic processes are thus morphologically indistinguishable. Clinical manifestations of cervical spondylosis may arise when morphologic sequelae are superimposed on a developmentally narrow spinal canal. The two clinical syndromes of spondylotic radiculopathy and myelopathy are distinct, yet they may overlap.

Diffuse idiopathic skeletal hyperostosis

The ubiquitous nature of spinal ligamentous calcification in the paleontologic record provides additional support for the suggestion that DISH is a protective phenomenon rather than a musculoskeletal disease, and perhaps represents a normal variant. Clinical assessment of contemporary DISH suggests a protective mechanical effect, paradoxically associated with increased risk of hypertension and cerebrovascular accident. DISH should probably not be considered a satisfactory explanation for back pain, but the presence of spinal ligamentous calcification requires that the patient be assessed for hypertension and that aggressive therapy be instituted for any found.

DISH at Merton Priory: evidence for a "new" occupational disease?

Images

Palaeopathology of spinal osteophytosis, vertebral ankylosis, ankylosing spondylitis, and vertebral hyperostosis

Five hundred and sixty intact skeletons and several thousand disarticulated vertebrae have been examined with special reference to spinal fusion. In period they ranged from a 21st dynasty Egyptian mummy to a mid-19th century skeleton. Osteophytes were found in about half of the specimens, as reported previously. Fifteen skeletons with extensive blocks of spinal fusion were also identified. Sacroiliitis was present in two, but the asymmetrical spinal disease and peripheral joint changes suggested Reiter's disease or psoriatic spondylitis rather than ankylosing spondylitis. The remaining 13 had typical features of Forrestier's disease, and extraspinal findings indicative of diffuse idiopathic skeletal hyperostosis (DISH) were also common. A review of the available literature suggests that many palaeopathological specimens previously reported as anklylosing spondylitis are examples of DISH or other seronegative spondylarthropathies. The antiquity and palaeopathology of AS needs reappraisal.

Intervertebral osteochondrosis in ancient and modern populations

Skeletal collections are often useful for determining the frequency and distribution of lesions that would otherwise go unnoticed in the living. This study examines a rather common spinal lesion for which there is little clinical or paleopathologic literature available. In such cases, the anterior aspect of the lower thoracic and lumbar vertebral plates display crescent-shaped lesions suggestive of a form of degeneration known as intervertebral osteochondrosis. A total of 2,628 skeletons from three early American Indian sites and one 20th-century medical-school cadaver population are examined for this lesion. Variables such as age, sex, weight, race, activity patterns, and other biocultural information are considered in relation to the frequency of this lesion. It is suggested that physical stress during the second and third decades of life is largely responsible for this condition. With advancing age the lesions are obliterated and, in effect, become indistinguishable from spondylosis deformans. Familiarity with this condition is necessary in order to better understand degenerative spinal disease and avoid confusion with other spinal diseases such as tuberculosis.

Arthritis in Saxon and mediaeval skeletons

Examination of 400 Saxon, Romano-British, and mediaeval skeletons from seven archaeological excavations in the west of England showed an unexpectedly high incidence of osteoarthritis and osteophytosis. Three skeletons had evidence of an erosive peripheral arthritis-one with probable gout, one probable psoriatic arthropathy, and one with possible rheumatoid arthritis. The pattern and types of rheumatic disease, and the resultant disability, were apparently different. An exuberant form of large joint osteoarthritis was common and rheumatoid arthritis and similar diseases rare.

[Comparative studies on the frequency of occurrence of degenerative spinal changes in neolithic, medieval and modern man]

105 judgeable spinal columns of neolithic cultures and 11 skeletons from the 11th and 12th century were examined for the presence spondylotic and spondylarthrotic changes of the spinal column taking into consideration the intensity and frequency of affection. With nearly the same affection per individual the frequency of affection in the neolithic population showed significantly lower values with relatively more frequent changes of the cervical vertebral column of the males and greater changes of the lumbar vertebral column in females. The neolithic and medieval group possess a different dependence on age. Apart from this, the medieval group shows an anticipation of the appearance of degenerative changes by about ten years compared with examinations from modern times. The reasons of these differences are discussed.

[View of the past: Roentgenography of an Egyptian mummy]

Report concerning roentgenographic examinations of an Egyptian mummy dating back to 900 B.C. from the "Museum für Völkerkunde Freiburg/Breisgau". The study was performed to detect funeral gifts which can be found otherwise only if the linnen bandage of the mummy is destroyed. Extraordinary findings were degenerative osteoarthritis of the spine and joints, pseudo-gout, marked caries of several teeth and signs for a healed occipital osteomyelitis. Suggestions are discussed about a particular compression of thorax and pelvis which is apparently due to the technique of bandaging. This was not observed in examinations of other mummies. Fractures of the first to third phalanges suggest forceful removal of precious rings. A circular-shaped opening in the parietal bone and a small radiodense foreign body which projects over the pharynx remain unexplained.