Coexistence of melorheostosis and DISH in a female skeleton from Magna Graecia (Sixth Century BC)

This paper reports on a case of massive hyperostotic alterations observed in the skeleton of an adult woman from the necropolis of Montescaglioso Belvedere (Basilicata, Southern Italy) attributed to the Enotrian culture and dated to the 6th century BC. Hyperostotic changes involve joints, the vertebral column, and the lower limbs. In particular, the large flowing ossification in both the thoracic (T6-T10) and lumbar (L2-L5) tracts, the sacralization of L5, accompanied by sacroiliac fusion on the left side, and the proliferative bone production on both the metaphyseal portion of the left tibia and the left third metatarsal are described. The vertebral antero-lateral ossification and the sacroiliac fusion support a diagnosis of diffuse idiopathic skeletal hyperostosis (DISH), while the flowing bone formation on the lower limbs supports a diagnosis of melorheostosis. The pathological conditions described here were already described in the literature, but this is the first reported case of the coexistence of DISH and the very rare melorheostosis. Furthermore, the skeleton from Montescaglioso Belvedere represents the first case of this disease described for ancient Europe, therefore adding a valuable contribution to the reconstruction of the antiquity and distribution of skeletal dysplasias.     

Diffuse idiopathic skeletal hyperostosis: Diagnosis in a palaeopathological context

Clinically, the presence of diffuse idiopathic skeletal hyperostosis (DISH) has been linked to a disturbance of glucose and insulin metabolism, hypertension, dyslipidemia and obesity associated with a rich diet. The prevalence of DISH in archaeological skeletal samples may therefore be a valuable indicator of their socio-economic status when compared to other contemporary groups. However, various methods are currently being used to diagnose DISH.The purpose of this study was therefore to assess the comparability of results obtained using four different diagnostic methods to estimate the prevalence of DISH in a skeletal sample, and to discuss the implications of the results in relation to palaeopathological health assessments.Four different diagnostic criteria were applied to 127 male and 113 female skeletons to diagnose DISH. Skeletal remains were obtained from two 16th century samples from Delft and one modern sample from the anatomy dissection hall of the Leiden University Medical Centre. The estimated prevalences were statistically compared. Special attention was also given to the distribution of extra-spinal enthesophytes described in diagnostic criteria, in order to assess their diagnostic value.The prevalence of DISH observed in the skeletal samples varied significantly depending on the criteria used for diagnosis. Furthermore, extra-spinal enthesophytes, suggested as being indicative of DISH, proved to be variable and unreliable.It was concluded that it is of great importance to explicitly state and adhere to criteria employed for diagnosing DISH in both palaeopathological and clinical investigations in order to ensure reliable comparisons between studies. Also, DISH cannot be positively diagnosed solely based on the presence of extra-spinal enthesophytes.     

Inflammatory arthritis in Pongo

Abstract: As the arboreal ape, Pongo, has an unusual ground ambulation adaptation, it was of interest to assess the impact of Pongo gait on patterns of arthritis. While osteoarthritis was not identified in Pongo, 11% of individual skeletons were afflicted with an inflammatory, erosive arthritis. The presence of sacroiliac involvement and the nature and distribution of erosive lesions allowed definitive diagnosis of spondyloarthropathy. Character, distribution, and radiologic appearance revealed a picture distinguishable from spondyloarthropathy in other primates.     

Isotopic examination of links between diet,social differentiation,and DISH at the post‐medieval Carmelite Friary of Aalst,Belgium

Stable isotope ratios (δ¹³C and δ¹⁵N) were measured in human burials from the post‐medieval (16th–18th c. AD) Carmelite friary burial grounds at Aalst, a town in Flanders, Belgium. Dietary patterns of 39 adult individuals were analyzed, from a mixed monastic and lay population buried in three different locations, reflecting groups with differing social status. The data show significant variation in the consumption of perhaps meat, but certainly also marine protein between females and males. This result represents a remarkable continuity with medieval dietary patterns, suggesting that the social and economic changes of the early modern period had a limited effect on everyday life. When both sexes were examined together, individuals buried in the cloister garth consumed significantly less marine protein compared to people buried in the church, likely reflecting social stratification. No statistical differences were observed between isotopic values from the church and the cloister alley, suggesting a similarly diverse diet of the monastic part of the buried population and that of the richer lay population. Finally, the hypothesis that diffuse idiopathic skeletal hyperostosis (DISH) is linked to a diet rich in animal protein was tested. No systematic or statistically significant differences between pathological and non‐pathological bones from the same individuals affected with DISH were observed, and no statistical differences were found between individuals with DISH and individuals without DISH. Am J Phys Anthropol 153:203–213, 2014. © 2013 Wiley Periodicals, Inc.     

前路椎间盘减压融合与前路椎体次全切除减压融合治疗多节段颈椎病的疗效比较

目的:探索前路椎间盘减压融合与前路椎体次全切除减压治疗多节段颈椎病的疗效,为临床手术方式的选择提供依据。方法:收集我院骨科2008年6月到2014年6月收治的多节段颈椎病患者26例,按照患者手术方式分为研究组(13例)和对照组(13例),研究组给予前路椎间盘减压融合治疗,对照组给予前路椎体次全切除减压治疗,对比两组手术时间、术中出血量、术后住院时间,记录并分析两组术前和术后3月、6月、12个月JOA评分、颈椎总活动度、颈椎曲度、颈椎节段高度。结果:研究组手术时间、术中出血量低于对照组(P0.05);两组JOA评分术前、术后3月、6月、12个月逐渐升高(P0.05),术后12月组间差异有统计学意义(P0.05)。两组颈椎总活动度术前、术后3月、6月、12个月逐渐降低(P0.05),但是术后同时期组间差异无统计学意义(P0.05)。两组颈椎曲度与颈椎节段高度术后3月、6月、12个月差异有统计学意义(P0.05)。结论:前路椎间盘减压融合治疗多节段颈椎病较前路椎体次全切除减压治疗效果好,手术时间短、术中出血量少,并且颈椎曲度和节段高度恢复好。     

广州河涌污水暴露致食蚊鱼骨骼形态雄性化的影响

食蚊鱼(Gambusia affinis)骨骼发育具有性别二态性,雄鱼臀鳍与第14、15和16椎体脉棘的形态特化受雄激素所调控,因此可以作为生物标志物监测水环境中的雄激素污染。本文利用食蚊鱼臀鳍和椎体脉棘形态变化为指标,调查了生活在受城市废水严重污染的广州市河涌中的食蚊鱼受内分泌干扰物影响的现状。根据食蚊鱼生长情况和捕鱼的便利性,选择广州市海珠涌中下游宝岗大道段(BG)、洪德路段(HD)和黄埔涌中下游赤岗路段(CG)、苗艺路段(MY)4个采样点,同时设置不受城市废水污染的华南师范大学校区内的中心湖作对照点(REF)。测量了雌、雄食蚊鱼第4臀鳍条长度和第4与第6臀鳍条长度的比值,并采用食蚊鱼第14、15和16椎体脉棘的总长(L,μm)、投影长度(P,μm)、尾部尖端到脊柱的高度(D,μm),以及L︰D、P︰D和P︰L的比值来评价食蚊鱼骨骼形态变化。结果,与对照点相比,夏冬两季海珠涌和黄埔涌4个采样点成年雌性食蚊鱼的第4臀鳍条长度显著延长(P0.05或P0.01),第4与第6臀鳍条长度的比值明显增大(P0.05或P0.01),成年雌性食蚊鱼臀鳍显现形态雄性化的特征;尽管4个采样点成年雄性食蚊鱼第4臀鳍条长度均显著小于对照点(P0.01),但是所有采样点的成年雄性食蚊鱼第4与第6臀鳍条长度的比值则无明显差异(P0.05)。与对照点(REF)相比,夏冬两季海珠涌宝岗大道段(BG)、洪德路段(HD)和黄埔涌苗艺路段(MY)采样点成年雌性食蚊鱼第14、15、16椎体脉棘的投影长度(P)显著增加(P0.05或P0.01);海珠涌宝岗大道段(BG),黄埔涌赤岗路段(CG)和苗艺路段(MY)采样点成年雌性食蚊鱼的P︰D比值显著增加(P0.05或P0.01);海珠涌宝岗大道段(BG)和洪德路段(HD),黄埔涌苗艺路段(MY)采样点成年雌性食蚊鱼的P︰L比值也显著增加(P0.05或P0.01);成年雌性食蚊鱼的第14、15、16椎体脉棘出现了骨质增生,增长,并向前倾斜,显示不同程度的形态雄性化特征。可是,各采样点成年雄性食蚊鱼第14、15、16椎体脉棘的投影长度(P)、P︰D和P︰L比值则没有明显变化(P0.05)。结果表明,广州河涌水体中的环境内分泌干扰物对食蚊鱼产生明显的形态雄性化效应。     

Rheumatoid (Marie-Strumpell) spondylitis; technique of examination and importance of the costal joints

Rheumatoid spondylitis in the early prodromal stage may present a complex and obscure clinical picture making diagnosis difficult. It is in this early stage that roentgen examination of the small joints of the spine will often aid in or lead to the correct diagnosis of the disease in which the classical clinical symptoms and roentenographic findings in the sacroiliac fissure have not appeared and may never appear. The changes in these small joints, particularly in the costovertebral and costotransverse joints, are less obvious and require experienced and careful interpretation, but it is to these that the roentgenologist must direct his attention if he is to be of assistance in early diagnosis. A technical procedure for this examination is presented, along with a discussion of the clinical importance of changes at this site. Demonstration of involvement of the sacroiliac joints is of diagnostic importance, but this finding is no more necessary to the diagnosis of rheumatoid spondylitis than is involvement of any other single joint of the spine. Insistence on sacroiliac involvement will often result in missed diagnosis, and has led in part to erroneous conclusions as to sex incidence of the disease.     

An investigation of age‐related changes at the acetabulum in 18th–19th century ad adult skeletons from Christ Church Spitalfields,London

The age‐markers described at the adult acetabulum by Rissech et al. (J Forensic Sci 51 (2006) 213–229) were scored in the Spitalfields collection of skeletons of documented age and sex (N = 161). The purpose of the work was as a contribution to the evaluation of the general utility of these markers for estimating age at death. To this end, their relationship both with age, and with some other factors, was investigated. The latter comprised sex, general tendency toward bone formation in periarticular soft tissue (as measured by the occurrence of diffuse idiopathic skeletal hyperostosis), and occupation (as documented for some of the males). Of the seven Rissech et al. variables, only four were found to show a statistically significant relationship with age. The correlation between a composite score derived from a linear combination of these four variables, and age was similar to or greater than correlations between age and composite scores based on other age indicators reported in the literature for Spitalfields. Male acetabula aged at a greater rate than those of females. There was no relationship with the occurrence of DISH, but for occupation, those in nonmanual professions showed greater acetabular scores‐for‐age than those in manual trades. Am J Phys Anthropol 2012. © 2012 Wiley Periodicals, Inc.     

RHEUMATOID (MARIE-STRUMPELL) SPONDYLITIS,Technique of Examination and Importance of the Costal Joints

Rheumatoid spondylitis in the early prodromal stage may present a complex and obscure clinical picture making diagnosis difficult. It is in this early stage that roentgen examination of the small joints of the spine will often aid in or lead to the correct diagnosis of the disease in which the classical clinical symptoms and roentenographic findings in the sacroiliac fissure have not appeared and may never appear. The changes in these small joints, particularly in the costovertebral and costotransverse joints, are less obvious and require experienced and careful interpretation, but it is to these that the roentgenologist must direct his attention if he is to be of assistance in early diagnosis. A technical procedure for this examination is presented, along with a discussion of the clinical importance of changes at this site.Demonstration of involvement of the sacroiliac joints is of diagnostic importance, but this finding is no more necessary to the diagnosis of rheumatoid spondylitis than is involvement of any other single joint of the spine. Insistence on sacroiliac involvement will often result in missed diagnosis, and has led in part to erroneous conclusions as to sex incidence of the disease.     

Biomechanical comparison of the effects of anterior,posterior and transforaminal lumbar interbody fusion on vibration characteristics of the human lumbar spine

Previous studies have compared the effects of different interbody fusion approaches on biomechanical responses of the lumbar spine to static loadings. However, very few have dealt with the whole body vibration (WBV) condition that is typically present in vehicles. This study was designed to determine the biomechanical differences among anterior, posterior and transforaminal lumbar interbody fusion (ALIF, PLIF and TLIF) under vertical WBV. A previously developed and validated finite element (FE) model of the intact L1–sacrum human lumbar spine was modified to simulate ALIF, PLIF and TLIF with bilateral pedicle screw fixation at L4–L5. Comparative studies on dynamic responses to the axial cyclic loading in these developed models were conducted. The results showed that at the fused L4–L5 level, dynamic responses of the von-Mises stress in L4 inferior and L5 superior endplates for the ALIF, PLIF and TLIF models were increased compared with the intact model. The endplate stresses in the TLIF model were lower than in the ALIF and PLIF models, but the TLIF generated greater stresses in the screws and rods compared with the ALIF and PLIF. At other levels, a decrease in dynamic responses of the disc bulge, annulus stress and intradiscal pressure was observed in all the fusion models compared with the intact one, but there was no obvious difference in these dynamic responses among the ALIF, PLIF and TLIF models. These findings might be useful in understanding vibration characteristics of the whole lumbar spine after different types of fusion surgery.     

Heterotopic ossification in a patient with diffuse idiopathic skeletal hyperostosis: Input from histological findings

A high incidence of heterotopic ossification (HO) has been reported in patients with diffuse idiopathic skeletal hyperostosis (DISH), a metabolic disease characterized by calcifications of entheses at spine and peripheral sites. We performed histological and immunohistochemical analyses in five different HO sites in a patient with DISH to study a possible mutual interaction of bone morphogenetic protein 2 (BMP-2), transforming growth factor beta (TGF-β), and decorin, crucial for bone mass increasing, matrix calcification, and endochondral bone formation. We speculated that the surgical trauma triggered HO, inducing TGF-β release at the lesion site. TGF-β recruits osteoblast precursor cells and determines the overexpression of BMP-2 in the surrounding skeletal muscle, inducing a further osteogenic differentiation, contributing to HO onset.Key words: heterotopic ossification, DISH, BMP-2, TGF-beta, decorin     

Comparison of outpatient and inpatient spa therapy in knee osteoarthritis

Osteoarthritis (OA) is a common condition that impacts many people worldwide and involves weight-bearing joints, resulting in chronic pain. In this study, we aimed to compare the effectiveness of inpatient and outpatient physical therapy modalities and spa combination treatments on pain and functional status in patients with knee osteoarthritis. Seventy-four patients diagnosed with primary knee osteoarthritis were included in this study. The patients were randomized into two groups, inpatient (n?=?37) and outpatient (n?=?37) physical therapy. All patients received a physical therapy program (superficial heater + deep heater + transcutaneous electrical nerve stimulation) for 2 weeks and spa therapy. All cases were evaluated clinically, laboratory, and radiographically. In order to evaluate pain and functional status, the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities osteoarthritis index (WOMAC), and Timed Up and Go (TUG) test were used before and after treatment. There was no significant difference between the two groups in the TUG test and WOMAC scores (p?>?0.05). However, a significant difference was found in VAS scores in favor of the outpatient group (p?<?0.05). As a result, although there was a significant improvement in pain scores in the outpatient group, multicenter studies with larger patient groups may provide more evidence.

     

Survived spondyloptosis of the thoracic spine in the Early Middle Ages (Czech Republic)

At a Slavic site Pohansko near B?eclav (Czech Republic), at the burial ground around the church (9th–10th century) 757 skeletons (208 males, 159 females, 354 sub-adults and 36 undetermined individuals), were excavated. More or less complete vertebral column was preserved in 109 adults. Among those, in the grave number 403, the skeletal remains of an adult male were found with the deformity of the spine probably caused by severe trauma (spondyloptosis). Due to the poor preservation of the caudal part of the spine, we cannot exclude diagnoses including spondylitis tuberculosa and developmental defects of the spine such as the persistence of neurocentral synchondroses, or the retrosomatic cleft. Considering the first possible diagnosis to be the most probable, it would be the first survived case of spondyloptosis identified in the palaeopathological literature.     

Sex differences in activity-related osseous change in the spine and the gendered division of labor at Ensay and Wharram Percy, UK

Sex differences in the distribution of vertebral degenerative and plastic change were examined and compared within and between samples of 51 individuals from the historically and ethnographically documented 16th-19th century site of Ensay, the Outer Hebrides, and 59 individuals from the medieval site of Wharram Percy, the Yorkshire Wolds. Both populations have a known gendered division of labor between males and females and known activity-related stresses on the spine. Osseous changes normally associated with degenerative joint disease (osteoarthritis) of the apophyseal facets and osteophytosis of the vertebral bodies were scored and reported separately. Inter- and intrasite differences were found in the frequency and distribution of osseous change down the spine. Overall, the Ensay sample was more highly stressed than that from Wharram Percy. Furthermore, differences between males and females at Ensay could be identified as relating to different types of activities. Distinctions between males and females at Wharram Percy were less marked, suggesting broadly similar lifestyles. These results accorded with expectations regarding contrasting levels of activity-related stress at the two sites and the division of labor between males and females. In particular, the prevalence and distribution of facet remodeling, facet sclerosis/eburnation, and osteophytosis in Ensay females could be related to load-bearing using creels (a form of basket), which disrupted "normal" patterns of osseous change along the spine. Importantly, morphologically distinct osseous modifications recorded on the apophyseal facets produced dissimilar distributions, suggesting that they may have different etiologies. These results highlight the need for a high degree of discrimination in recording, analyzing, and exploring activity-related osseous change.     

Degenerative spondylolisthesis in ancient and historic skeletons from New Mexico Pueblo sites.

The objective of this study was to identify the presence of degenerative spondylolisthesis in adult Native American skeletons recovered from prehistoric and historic Pueblo sites in New Mexico. The vertebral columns of 491 individuals that were complete enough to allow the necessary observations produced 64 cases, with a total of 74 affected levels. The L5-S1 level was affected most frequently (78%), in contrast to clinical and anatomical studies where the L4-L5 level was usually affected (80%). Age and sex were found to be important factors, with the condition limited to middle and old adults, and occurring in females over males at a ratio of approximately 5:1. Olisthesis was shown to occur only in association with severe osteoarthritis of the zygapophysial joints, but severe osteoarthritis did not always result in olisthesis, particularly in males. Parallel or convergent inferior articular processes were found to increase in frequency in the presence of olisthesis, apparently resulting from degenerative remodeling that produced the olisthesis. The data also suggest that individuals with cranial border shifting in the column may be especially prone to olisthesis. Degenerative olisthesis was also observed in the cervical region.     

盐酸氨基葡萄糖联合塞来昔布对膝关节骨性关节炎的临床疗效观察

目的:观察盐酸氨基葡萄糖联合塞来昔布治疗膝关节骨性关节炎的效果及对不同程度关节炎Lequesne评分的影响,为关节炎的临床治疗提供参考。方法:选取2012年6月至2014年3月我院收治的膝关节骨性关节炎患者60例,根据治疗方法不同,将所选患者分为观察组和对照组,每组30例。对照组患者给予盐酸氨基葡萄糖单药治疗,观察组患者给予盐酸氨基葡萄糖和塞来昔布联合治疗。观察两种治疗方案的不良反应发生率,比较两组患者治疗前后的Lequesne评分。结果:对照组患者不良反应的发生率为26.67%,观察组为23.33%,差异无统计学意义(P0.05)。两组患者治疗后的Lequesne评分均低于治疗前,且观察组患者Lequesne评分显著低于对照组,差异具有统计学意义(P0.05)。观察组不同程度膝关节骨性关节炎患者的Lequesne评分均显著低于对照组,差异具有统计学意义(P0.05)。结论:盐酸氨基葡萄糖联合塞来昔布治疗膝关节骨性关节炎具有良好的临床效果,应进一步推广应用。     

Utilization trends of pedicle subtraction osteotomies compared to posterior spinal fusion for deformity: a national database analysis between 2008–2011

Background

Increased awareness regarding the importance of the sagittal spinal profile has led to more aggressive correction of sagittal malalignment. The utilization trends of pedicle subtraction osteotomy (PSO) for sagittal plane correction in spinal deformity surgery have not been well characterized.

Methods

A commercially available database (PearlDiver, Inc) was queried for both Private Payor and 5 % Medicare claims from 2008 to 2011. Revision and clarification of the coding guidelines for PSO were introduced in 2008. Patients who had a thoracic and/or lumbar PSO were identified using CPT codes (22206-22208). In order to appropriately interpret trends in PSO use, three comparison groups were identified. Patients who had a diagnosis of adult spine deformity were identified using ICD-9 codes. Patients who had fusion for spine deformity or posterior spine fusion were identified using CPT codes. Differences in annual utilization and demographics between these four groups were then compared.

Results

From the Private Payor database, 199 PSOs were identified with the number of PSOs increasing from 33 in 2008, to 61 in 2011, representing a 185 % increase. From the Medicare data, 102 PSOs were identified, increasing from 13 in 2008 to 32 in 2011, a 246 % increase. In contrast, from both databases, there was minimal to no increase in the incidence of adult spine deformity, fusion for spine deformity or posterior spine fusion over the study time interval.

Conclusion

Over the study time interval, there was up to a 3.2-fold increase in the utilization of PSOs while the diagnosis of adult spine deformity, fusion for spine deformity and posterior spine fusions had minimal to no increase.

     

Investigation of the link between visceral surface rib lesions and tuberculosis in a Medieval skeletal series from England using ancient DNA

Seven human skeletons from a large assemblage from a rural English Medieval burial site show lesions, predominantly proliferative in nature, on the visceral surfaces of the ribs. In order to investigate whether these rib lesions were regularly associated with tuberculous infection, these individuals, together with a group of age- and sex-matched control skeletons without bony signs of infection, were subjected to polymerase chain reaction (PCR) assays aimed at detecting traces of DNA from infecting microorganisms of the Mycobacterium tuberculosis complex. The results provided no evidence for any regular association between visceral surface rib lesions and the presence of M. tuberculosis complex DNA in the study group. The significance of these findings for the paleopathological interpretation of visceral surface rib lesions is discussed.     

Variation of the degree of sacral vertebral body fusion in adulthood in two European modern skeletal collections

A new standardized scoring method was used to study age variation of the degree of fusion of the ventral face of the sacral vertebral bodies (SVF) in 904 adult skeletons of both sexes from two identified modern samples (20th c.): Frassetto collections (Museum of Anthropology, University of Bologna, Italy) and Colecção de Esqueletos Identificados (Museum of Anthropology, University of Coimbra, Portugal). SVF was scored for each fusion site (between S₁ and S₂, etc.) on a four‐stage scale, from nonfusion (Degree 0) to complete fusion (Degree 3). Inter‐observer error of 1.2% suggested good reproducibility. The data were analyzed according to age, sex, and population. There were sex and population differences only in young adults (20–34 years). Sex differences in SVF were present in both collections, with females displaying earlier fusion than males. The differences occurred until 35 years, after which there was a generalized prevalence of completely fused sacra. Population differences were observed for males, with the Sassari men showing later sacral vertebral fusion than the Coimbra men. Our study suggests that incompletely fused sacra can help in distinguishing young adults from old adults regardless of sex and population. Am J Phys Anthropol 135:149–160, 2008. © 2007 Wiley‐Liss, Inc.     

Association Study of Polymorphisms rs4552569 and rs17095830 and the Risk of Ankylosing Spondylitis in a Taiwanese Population

Ankylosing spondylitis (AS) is a chronic inflammation of the sacroiliac joints, spine and peripheral joints. However, the development of anklosing spondylitis is unclear. Human leukocyte antigens HLA-B27 and ERAP1 have been widely reported to be associated with AS susceptibility. A recent genome-wide association study (GWAS) showed that two new susceptibility loci between EDIL3 and HAPLN1 at 5q14.3 (rs4552569) and within ANO6 at 12q12 (rs17095830) contribute to the risk of AS in Han Chinese. In this study, we enrolled 475 AS patients and 475 healthy subjects to assess whether these genetic variations contribute to the susceptibility and the severity of AS in the Taiwanese population. The correlation between genetic polymorphisms, AS activity indexes, (namely, BASDAI, BASFI and BAS-G) and AS complications (uveitis and inflammatory bowel disease) were tested using the markers, rs4552569 and rs17095830. Although no association between rs4552569/rs17095830 genetic polymorphisms and AS susceptibility/severity was found, a significant association between rs17095830 and inflammatory bowel disease was observed in a Taiwanese population.