History of spine surgery for tuberculous spondylodiscitis.

For those stricken with tuberculosis, a disease that was present in ancient times, treatment was originally limited to conservative treatment including high altitude, fresh air, rest, and immobilization, manual reduction devices, and surgical procedures. Mortality and morbidity were high until the advent of antitubercular chemotherapy in the 1940s. Today multidrug regimen enable good disease clearance and also make direct surgical debridement without complications possible. Antitubercular drugs have reduced mortality by 72.5%. Surgical intervention is reserved for selected situations.

Historical aspects of Pott's disease (spinal tuberculosis) management.

INTRODUCTION: Spinal tuberculosis has existed in human beings since the ascent of man on earth. Historically, the management has progressed from regional orthodox therapies to the current, more effective, drugs. MATERIALS AND METHODS: Historical perspectives regarding the management have been collated by going through the important publications during the past 6 decades. For convenience, the manuscript has been organized as "orthodox traditional" treatment, early "chemotherapy period", "post chemotherapy treatment", "middle-path" philosophy, and the current treatment with availability of modern imaging facilities. CONCLUSIONS: Broad conclusions based upon the published data and personal observations (1959-2011) are summarized as follows: If diagnosis is made at predestructive stage and the patient is treated by standard drugs, the infection would heal in about 95 % patients without significant deformities and complications. Neural complications are still encountered in general hospital outpatients. Diagnosis and treatment at early stages would resolve the neurology without operation in about 40 % of cases. Nearly 60 % of patients would require to be operatively decompressed without jeopardizing mechanical stability. However, despite current treatment approximately 8 % of tuberculous paraplegics do not recover functionally. Immunocompromised state and multidrug resistance to standard drugs (8 to 10 %) are the current (and future) challenges to the doctors and the society.

Rib lesions in skeletons from early neolithic sites in Central Germany: on the trail of tuberculosis at the onset of agriculture.

As an infectious disease, tuberculosis (TB) is one of the major causes of death worldwide. Paleopathological and paleomicrobiological studies indicate a long standing association of the causative agent Mycobacterium tuberculosis and its human host. Since the occurrence and the epidemic spread of this pathogen seem to be closely linked to social and biological factors, it is of particular interest to understand better the role of TB during periods of social and nutritional change such as the Neolithic. In this study, 118 individuals from three sites in Saxony-Anhalt (Germany) dating to the Linear Pottery Culture (5400-4800 BC) were examined macroscopically to identify TB related bone lesions. In two individuals, Pott's disease was detected. In addition, periosteal reactions of varying degrees and frequency were observed mainly along the neck of the ribs in 6.5% (2/31) of subadults and 35.1% (20/57) of adults, with one site standing out markedly. Rib lesions, however, are not specific indicators of TB as they can also be caused by other diseases; so additional investigations were undertaken using histology and micro-CT scans to say more about the disease process. Supplementary molecular analyses indicate the presence of pathogens belonging to the Mycobacterium tuberculosis complex in individuals of all sites. Furthermore, we discuss the occurrence and spread of TB during the Neolithic with regard to nutritional aspects and possible risks of infection. The data presented provide important insights into the health status of Early Neolithic populations in Central Germany.

Bone tuberculosis in Roman Period Pannonia (western Hungary).

The purpose of this study was to analyse a skeleton (adult female, 25-30 years) that presented evidence of tuberculous spondylitis. The skeleton, dated from the Roman Period (III-VI centuries), was excavated near the town of Gyor, in western Hungary. The skeleton was examined by gross observation supplemented with mycolic acid and proteomic analyses using MALDI-TOF/TOF tandem mass spectrometry. The biomolecular analyses supported the morphological diagnosis.

The History of Anterior and Lateral Approaches to the Lumbar Spine.

Anterior and lateral approaches to the lumbar spine are commonly used today for a variety of indications. These approaches can ultimately be traced back to early attempts to treat Pott's disease. Evidence of Mycobacterium tuberculosis infection of the spine dates as far back as 2400 BCE, with ancient Egyptian mummies exhibiting lesions consistent with Pott's disease. For many centuries, Pott's disease was treated conservatively, and surgery came to be used when conservative therapy was ineffective, as medical therapy had yet to become available. In 1779, Percivall Pott recommended that peripheral paraspinal tuberculous abscesses be drained after noticing that patients' lower limb function improved after the formation of spontaneous draining sinuses. Building on Pott's ideas, Ménard described the first lateral approach to the spine via a costotransversectomy approximately 1 century after Pott's theory. Most importantly, the surge in understanding anatomy with respect to developing safe corridors to the deeper structures of the human body brought together advances in technology, instrumentation, and visualization. Surgeons were thus emboldened to explore more complex anterior approaches to the spine. In 1906, Müller reported the first successful anterior approach to the spine in a patient with Pott's disease. Over the next several decades, the efforts of surgeons such as Ito, Capener, Burns, and Mercer would lead to the development of the anterior lumbar interbody fusion. The costotransversectomy later evolved into the lateral rhachotomy and lateral extracavitary approach, which along with advances in the anterior lumbar interbody fusion paved the way for the oblique lumbar interbody fusion and lateral lumbar interbody fusion.

Rheumatoid arthritis, Klippel-Feil syndrome and Pott's disease in Cardinal Carlo de' Medici (1595-1666).

OBJECTIVE: A paleopathological study was carried out on the she skeletal remains of Cardinal Carlo de' Medici (1595-1666), son of the Grand Duke Ferdinando I (1549-1609) and Cristina from Lorraine (1565-1636), to investigate the articular pathology described in the archival sources. METHODS: The skeletal remains of Carlo, buried in the Basilica of San Lorenzo in Florence, have been exhumed and submitted to macroscopic and radiological examination. RESULTS: The skeleton of Carlo revealed a concentration of different severe pathologies. Ankylosis of the cervical column, associated with other facial and spine anomalies suggests a diagnosis of congenital disease: the Klippel-Feil syndrome. In addition, the cervical segment presents the results of the tuberculosis (Pott's disease) from which the Cardinal suffered in his infancy. The post-cranial skeleton shows an ankylosing disease, mainly symmetrical and extremely severe, involving the large as well as small articulations, and characterized by massive joint fusion, that totally disabled the Cardinal in his last years of life. CONCLUSIONS: The final diagnosis suggests an advanced, ankylosing stage of rheumatoid arthritis.

A male adult skeleton from the Han Dynasty in Shaanxi, China (202 BC-220 AD) with bone changes that possibly represent spinal tuberculosis.

Bioarchaeological data for tuberculosis (TB) have been published very sporadically in China or the rest of East Asia. To explore the history of TB in this area, 85 skeletons excavated from the Liuwei Cemetery in Shaanxi, China (202 BC-220 AD) were macroscopically examined to record TB related bone changes. These skeletons represented inhabitants of Maolingyi, an urban area that had a high population density during the Han Dynasty (202 BC-220 CE). Seventeen of the 85 skeletons had spines that were well enough preserved to observe evidence of spinal disease. Among them, a male skeleton aged around 30 years (M34-E) manifested multiple lytic lesions in the eleventh thoracic to second lumbar vertebral bodies (T11 to L2). TB was considered a possible diagnosis for the spinal lesions observed, with differential diagnoses of brucellosis and typhoid. The dense population and overcrowding in urban Maolingyi were considered the potential social risk factors for TB found at this site. The findings of this study contribute to limited knowledge about the history of TB in East Asia and suggest a relationship between population density and the spread of TB in Maolingyi at that time. However, the lack of published bioarchaeological data of TB in East Asia hinders understanding the transmission of TB within Asia and its link to the rest of the world. Further intensive review of archaeological skeletons in Asia is urgently needed. 。, 。85, 17, 。, 30、、。, 。, 。、, , 。, 。, 。.

Possible new evidence of pre-Columbian tuberculosis in America: Pott disease in a prehistoric Mexican statue.

The authors present a case of a probable Pott disease from central/southern Mexico, dated 300 BC to 500 AD. This case highlights the importance of iconotopsy/iconodiagnosis for a better description of the natural history of diseases, especially as a complement to morphological analyses of human remains (paleopathology) and laboratory exams (DNA or immunology testing).

A 'cold case' of care: Looking at old data from a new perspective in mummy research.

In 1973, analysis of the mummified remains of a young boy dated to 700AD and from the Late Nasca period (Peru) identified (i) chronic Pott's disease, leading to loss of lower body mobility, and (ii) acute miliary tuberculosis, affecting most organs and the immediate cause of death (Allison et al., 1973). This report was the first to establish, beyond dispute, the presence of tuberculosis in the Americas before the arrival of Europeans. Here, we revisit the 'Nasca Boy' from a bioarchaeology of care perspective. Contextualising the original study's results within what is known of contemporary lifeways, we apply the bioarchaeology of care methodology in considering the Nasca Boy's experience of living with tuberculosis; the type of care he required and how this may have evolved over a period of deteriorating health; and what such caregiving may suggest both about social organisation within his community and some of the more everyday aspects of Nasca existence. Up to now, the bioarchaeology of care approach has been employed almost exclusively with skeletal evidence; in this analysis of the Nasca Boy's remains, and in the accompanying wider-ranging discussion, we illustrate the potential of preserved soft tissue evidence to contribute to research into disability and care in the past. Although this report functions as a stand-alone case study, to obtain maximum benefit it should be read in conjunction with the Introduction to the special International Journal of Paleopathology issue on 'mummy studies and the bioarchaeology of care' (Nystrom and Tilley, 2018).

A paleopathological approach to early human adaptation for wet-rice agriculture: The first case of Neolithic spinal tuberculosis at the Yangtze River Delta of China.

The earliest evidence of human tuberculosis can be traced to at least the early dynastic periods, when full-scaled wet-rice agriculture began or entered its early developmental stages, in circum-China countries (Japan, Korea, and Thailand). Early studies indicated that the initial spread of tuberculosis coincided with the development of wet-rice agriculture. It has been proposed that the adaptation to agriculture changed human social/living environments, coincidentally favoring survival and spread of pathogenic Mycobacterial strains that cause tuberculosis. Here we present a possible case of spinal tuberculosis evident in the remains of a young female (M191) found among 184 skeletal individuals who were Neolithic wet-rice agriculturalists from the Yangtze River Delta of China, associated with Songze culture (3900-3200 B.C.). This early evidence of tuberculosis in East Asia serves as an example of early human morbidity following the adoption of the wet-rice agriculture.

Brief communication: new evidence of tuberculosis from prehistoric Korea-Population movement and early evidence of tuberculosis in far East Asia.

Tuberculosis has been recognized in Japan and Korea for more than 500 years in historical medical documents. However, the origin and early existence of tuberculosis is poorly understood in these regions. Very recently, skeletal evidence for tuberculosis from the Bronze Age (or Aneolithic) period was reported from Japan and Korea. This article describes a possible case of spinal tuberculosis from an archeological site in Korea, which was dated to the first century BC. This date corresponds to the Aneolithic (Yayoi) period in Japan. Skeletal evidence for tuberculosis during the Bronze Age period found in both Korea and Japan are, therefore, discussed as evidence of the earliest tuberculosis outbreaks in East Asia and as biological indicators of population movement between Korea and Japan during this period.

Archaeological evidence for Pott's disease on historical populations: Tomb 05 at the Roman Circus maqbara as an example of social solidarity (Toledo, Spain).

ABSTRACT: World societies can often be characterized by their attitude towards elderly and illness. It is well known that most cultures were concerned about those who were not able to produce and take care of themselves. This brings to the development of social processes that involve such individuals within the community, resulting in groups who stick together, and at last, ensuring the survival of the group. The contextualization of many of those social processes might be studied through Physical Anthropology and Paleopathology. This paper presents tomb 05 (T-05) as a new case of probable tuberculosis in Toledo from the medieval maqbara of the Roman Circus that provides new paleoanthropological data to understand the treatment given to sick people in a sparsely studied context.

[Cripples at the medieval hospital of Bátmonostor, Hungary--archeological findings]. / Egy magyarországi közepkori ispotály (Bátmonostor) beteganyaga az ásatási leletek tükrében.

Cripples from the medieval hospital of Bátmonostor, Hungary. People with disabilities were generally burdened with a painful fate in ancient times, however in the hospitals was no effective therapy. The hospital of Batmonostor was founded at late 13th century, The authors examine by morphological, radiological and histological methods 426 complete skeletons excavated from medieval (14th-15th century) cemetery of Bátmonostor (Hungary). Among them 30 cases (7.1%) of bony ankylosis, (24 cases on lower limb and 6 cases on upper limb) was found. Sacroiliac ankylosis 3 cases, Bechterew's spondylitis ankylopoetica 1 case was seen. Spondylitis tuberculosa and malum Potti 4 cases, and hunchback with other aetiology 2 cases was detected. Beside the cases with ankylosis severe posttraumatic osteomyelitis (7 cases), primary malignant bone tumors (2 cases) and an osteoplastic metastatic tumors (probably prostata carcinoma) was diagnosed. Paleopathologic study of the physically disabled may yield information and insight on the prevalence of crippling disorders. The authors hypothetize, that crippled persons lived in the hospital until their deaths.

[Pott's disease before antibercular agents: from Pott to Ménard]. / Le mal de Pott avant les antituberculeux: de Pott à Ménard.

Percival Pott (1714-1788), an eminent surgeon, has given his name to a spinal pathology with curvature due to tuberculous abscesses; he was the first to show that it may cause paralysis of the lower limbs and that tragic consequences could be avoided or reversed through surgery. Victor Auguste Ménard (1854-1934) played a major role in the orthopaedic treatment of this disease in the Maritime Hospital of Berck-sur-Mer where he was the founder of a surgeon school. In 1900, he published a work entitled : A Practical Study of Pott's Disease. Since there were no antibiotics to treat tuberculosis and because most patients were children, they had to be submitted to intensive care. Ménard's treatment consisted of a complete and long immobilization associated to strict rules of hygiene, involving sun and sea-air therapy. The use of surgery in some cases recalls Pott's general principles.

Three-dimensional imaging of past skeletal TB: From lesion to process.

3D imaging has become an essential tool in the field of biological anthropology, notably for human evolution purposes. High resolution virtual 3D reconstructions of original specimens contribute to their preservation and broaden the ability for research, teaching and exchanges. Paleopathology can get substantial benefit from these methods, among others for reconstructing infectious pathological processes on ancient bones. Tuberculosis is frequently diagnosed on ancient human remains; however, some osseous expressions are difficult to interpret using classical methods. We illustrate here the interest of 3D methods for reconstructing processes involved in pathological bone changes due to Mycobacterium tuberculosis infection. Four paleopathological specimens attributed to this infection, dating from different time periods and concerning diverse parts of the skeleton have been analyzed using a specific 3D digital chain we have previously developed. These 3D analyses allow to virtually reconstruct the initial location and aspect of the infectious process, its extension as well as its possible diffusion to the surrounding soft tissues. This possible virtual follow-up of the disease leads to the concept of processual paleopathology that we would like to introduce in the field. The 3D methodology can help to improve our knowledge of natural history and evolution of ancient human infections such as tuberculosis.

Unusual spinal tuberculosis in an Avar Age skeleton (Csongrád-Felgyo, Ürmös-tanya, Hungary): A morphological and biomolecular study.

The paleopathological analysis of a well-preserved young adult female skeleton from the AD 7-8th century (Avar Age) in Hungary revealed multiple lytic lesions in all of the thoracic and lumbar vertebral bodies. The lesions were characterized by smooth marginal zones and space-occupying mass appearance. The considerable loss of spongy bone in the thoracolumbar vertebrae resulted in angular deformity and fusion, characteristic of the healing stage of TB. Osteolytic lesions were also observed on the vertebral processes, ribs and sternum. On the endocranial surface, abnormal blood vessel impressions were revealed, indicating some kind of meningitis. The X-ray and CT analysis of the affected bones detected abnormal structures and cystic zones of destruction. The lesions were however not always bordered by areas of increased density, which is typical in cystic TB. Vertebral remains were also subjected to biomolecular analysis in two different laboratories, which attested the presence of Mycobacterium tuberculosis complex (MTBC) DNA and supported the paleopathological diagnosis of TB. Spoligotyping analysis confirmed the presence of MTBC DNA and more specifically an infection caused by bacteria belonging to the M. tuberculosis lineage. This case study provides new data for the paleoepidemiology of TB in this geographical area and historical period, and draws attention to the great variability of TB lesions in the human skeleton.

7000 year-old tuberculosis cases from Hungary - Osteological and biomolecular evidence.

This study derives from the macroscopic analysis of a Late Neolithic population from Hungary. Remains were recovered from a tell settlement at Hódmezovásárhely-Gorzsa from graves within the settlement as well as pits, ditches, houses and as stray finds. One of the most important discoveries from these remains was evidence of tuberculosis. Pathological analysis of the seventy-one individuals revealed numerous cases of infections and non-specific stress indicators on juveniles and adults, metabolic diseases on juveniles, and evidence of trauma and mechanical changes on adults. Several cases showed potential signs of tuberculosis and further analyses were undertaken, including biomolecular studies. The five individuals were all very young adults and included a striking case of Hypertrophic Pulmonary Osteopathy (HPO) with rib changes, one case with resorptive lesions on the vertebrae, two cases with hypervascularisation on the vertebrae and periosteal remodelling on the ribs, and one case with abnormal blood vessel impressions and a possible lesion on the endocranial surface of the skull. The initial macroscopic diagnosis of these five cases was confirmed by lipid biomarker analyses, and three of them were corroborated by DNA analysis. At present, these 7000-year-old individuals are among the oldest palaeopathological and palaeomicrobiological cases of tuberculosis worldwide.