A review of the embryological development and associated developmental abnormalities of the sternum in the light of a rare palaeopathological case of sternal clefting.

A sternal cleft or bifid sternum is a rare anterior chest wall abnormality. Although several cases have been reported in clinical literature, very little reference has been made to this anomaly in palaeopathological texts. This paper presents a case of superior sternal clefting observed in a middle-aged female with concurrent Paget's disease and congenital hyperkyphosis excavated from a 19th century Dutch psychiatric asylum cemetery in Bloemendaal, The Netherlands. The embryological development of the sternum and associated developmental abnormalities are reviewed and a differential diagnosis is performed on the suite of observed skeletal anomalies. Goltz syndrome, congenital hypothyroidism, disruption of the Hoxb-4 gene, acute excessive maternal alcohol consumption during pregnancy, Coffin-Lowry syndrome and PHACES syndrome were considered as possible causative agents, with the latter two conditions determined to be the most likely. The psychiatric asylum context, from which the individual came, supports the differential diagnosis as neurological abnormalities are common in these two syndromes. This article demonstrates that the integration of embryology, modern clinical literature and palaeopathological principles is vital in the interpretation of developmental anomalies from an archaeological context.

Hiatal hernia and disorders of the spine: a historical perspective.

Our understanding of esophageal disease and the foregut has evolved over the past 100 years, especially in recent times. Modern diagnostic technologies and new management paradigms have provided progressive insights into the anatomy, physiology, and normal and abnormal function of the esophagus, as well as improving patient care. Yet, the relationship between the esophagus and its close neighbor, the spine, is rarely discussed and likely underappreciated. Anatomic proximity and intertwined pathophysiology led early investigators to postulate relationships between esophageal disease and spinal abnormalities. More recent studies have illustrated a link between spinal disease and hiatal hernias. Objective radiographic measurements of kyphoscoliosis have correlated with increased hiatal hernia formation. Spinal abnormalities and disease of the esophageal hiatus are becoming more common in our aging population, with each carrying significant risk of morbidity and decreased quality of life. Operative planning and subsequent hiatal hernia repair must be undertaken in the context of these spinal abnormalities. A historical review of past publications related to the subject forms the basis for this publication, thus revealing insight and improving our understanding of the association between spinal abnormalities and hiatal hernias.

Development and growth of anterior spine surgery in Minnesota.

Until the 1960s, it was not possible to directly access the thoracic vertebrae in order to correct conditions such as congenital kyphosis. Attempts to treat problems using traditional posterior spine surgeries often failed, leaving patients paraplegic. Using a procedure initially done in Hong Kong, surgeons from the University of Minnesota in 1966 became some of the first in the United States to access the thoracic spine from the anterior position, allowing for correction of deformities. This article highlights Minnesota surgeons' contributions to the development of anterior spine surgery.

[G. F. d'Acquapendente and Don Carlo Medici's gibbosity]. / Alla corte dei medici: Girolamo Fabrizio d'Acquapendente e la "Gobba" di Don Carlo.

Don Carlo dei Medici (1595-1666) is the son of Ferdinando I (1549-1609), Granduca of Tuscany, and becomes Cardinal of Catholic Roman Church in 1615. In 1604 Fabrizio d'Acquapendente is called in Florence to treat him, because of an aggravation of his health, and of his congenital neck's gibbosity. The recent paleopathological researches have diagnosed his congenital cervical gibbosity as effect of the Klippel-Feil's syndrome, and characteristic lesions of tubercolosis.

Management of spinal disorders and trauma in Avicenna's Canon of medicine.

WE STUDY HISTORY in an attempt to achieve a wide perspective of life and reality. Spinal disorders, particularly spine traumas and their complications, have been one of the most challenging problems throughout the history of medicine and, indeed, throughout the history of humanity. The pioneers and founders of scientific medicine committed much of their lives to understanding these disorders. There is a paucity of historical documentation. From the extraordinary efforts of early practitioners, we may glean insight relevant to the more effective treatment of such debilitating disorders. Ibn Sina (Avicenna), who lived in the medieval period, was one such physician. His principal book of medicine, The Canon, played a fundamental role in the practice of medicine in the Eastern and Western worlds between the 11th and 17th centuries. In this book, published in the 11th century, he provided detailed accounts of spinal disorders and strategies for their management. Here, we provide a brief review of Avicenna's most significant points concerning spinal diseases and their treatment from the chapters of the Canon. Although, there are not basic differences from Hippocratic knowledge, this book contains some original contributions.

[Rokitansky's first description of a spondylocostal dysplasia, dysostosis]. / Rokitanskys Erstbeschreibung einer spondylokostalen Dysplasie.

The bicentenary of Carl Rokitansky's birth prompted us to evaluate his less well-known work related to osteopathology. Of various articles containing humoropathological interpretations of osseous diseases, one work should be highlighted. It is, to the best of our knowledge, the first description of a spondylocostal dysplasia, re-discovered many years later, precisely described and accompanied by an excellent illustration.

Paleopathological examination of medieval spines with exceptional thoracic kyphosis most likely secondary to spinal tuberculosis. Historical vignette.

Spinal tuberculosis (TB) infrequently involves more than one to three vertebrae, and kyphotic angulation of greater than 30 degrees is rare in paleopathological specimens and clinical studies. The authors describe findings obtained in two spines (dating from the Early and Late Middle Ages). Spinal TB was present in both as well as sharply angulated kyphosis (approximately 180 degrees) resulting from complete destruction of five and seven vertebral bodies, respectively. In these two specimens obtained in individuals older than 12 years of age at the time of death we observed no involvement of the disease in posterior vertebral elements, and the laminae showed osseous fusion without signs of infection. The osseous diameter of the spinal canal was not narrowed in either case. These findings are discussed in the context of modern medical knowledge and paleopathological and genetic examinations.

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.

Historical perspective milestones in the evolution of lumbar spinal postural health in seating.

The best knowledge on seated posture before the Enlightenment was not scientific, but influenced by sociocultural, economic, and manufacturing factors. Although the pursuit of knowledge related to spinal postural health was advanced with the advent of empirico-analytic research, academic opinion continued to be influenced by unsubstantiated information, often resulting in incorrect advice to the public. Only in the past decade has advice on "correct" seated posture, spanning the time from the Hippocratic texts to the present, been brought into question by evidence-based research. By exploring seating from 3100 B.C to the present, this article discusses key influences that have an impact on seating functional to spinal postural health. Emphasis is placed on the role of medical opinion.

[Idiopathic scoliosis and Scheuermann's kyphosis. Historical and current aspects of conservative treatment]. / Idiopathische Skoliose und Scheuermann-Kyphose. Historische und aktuelle Aspekte der konservativen Behandlung.

Although in practice since antiquity the nonoperative treatment of spinal deformities is still controversial. Giving preference to orthotic treatment and physiotherapy the historical development of nonoperative treatment will be demonstrated by the examples of idiopathic scoliosis and Scheuermann's kyphosis. It is surprising how early essential and still valuable principles of nonoperative treatment had been acquired and how many of the present-day concepts have remarkable forerunners in the 19th century. In the light of previous knowledge and personal experience the indication, practice and realistic capabilities of modern nonoperative treatment of idiopathic scoliosis and Scheuermann's kyphosis are pointed out.

[Pott triad and Schmorl nodules. A historical overview of kyphosis with special reference to tuberculous spondylitis and Scheuermann disease]. / Von Pott-Trias und Schmorl-Knoten. Ein geschichtlicher Uberblick zur Kyphose unter besonderer Berücksichtigung der tuberkulösen Spondylitis und des Morbus Scheuermann.

This report provides an overview of the history of the different types of kyphosis (arcuated and angulated forms). Especially tuberculous spondylitis and Scheuermann's disease are pointed out from among the large group of kyphotic diseases. Therefore, Beckhterew's disease, the combination of rickets and kyphosis as well as the dysraphic diseases and constitutional kyphosis caused by faulty posture are only mentioned. These two special types of kyphosis (Scheuermann's disease and tuberculous spondylitis) are presented from the first description with diagnostic findings, the ideas of pathogenesis and aspects of treatment through to the different periods of medical history. This article describes the way of thinking and discussing of opinion leaders at the beginning of the century and the influence of new techniques and developments (asepsis, antisepsis, anesthesia, bacteriology, X-ray, antibiotics) on the differential diagnosis and therapy. It is impossible to give a complete overview of all aspects during the centuries concerning tuberculous spondylitis or arcuated kyphosis. The authors of this article have focussed their studies on developments from the first descriptions until World War II, based mainly on literature from German journals and historical books from the library of the German Museum for Orthopedic History and Science.

The old and the new camptocormia.

A forced posture with a forward-bent trunk was termed camptocormia by the French neurologist Souques in 1915. In his case history, which consisted of young soldiers, the condition occurred acutely, was usually psychogenic, lasted for months, and could be cured quickly and durably by a "persuasive" electrotherapy. Numerous similar cases were observed during the World War I and II and immediately thereafter. In the last 10 years, the same term has been used to describe kyphotic postural anomalies resulting from a primary or neurogenic affection of the paravertebral muscles. This condition mainly occurs in older women, takes a chronically progressive course, and responds well to corticosteroid therapy. To avoid misunderstandings of nomenclature, this somatic disease should not be designated as camptocormia, but rather as thoracolumbar kyphosis in old age.

[Praying for the hunchback man. On the cultural history of scoliosis and kyphosis]. / Beten fürs bucklicht Männlein. Zur Kulturgeschichte der Skoliose und Kyphose.

Numerous ancient burial sites contain spines with scoliotic deformities. However, very little is known about the lives of these people, the "hunchbacks". Their everyday life, how they saw themselves and were seen by others, their social status and perspectives can usually only be deduced indirectly from a variety of sources. These include fairy-tales and myths, beliefs and superstitions, classical and light literature, and accounts by theological and philosophical writers. The present paper proves that severely deformed scoliosis patients were generally burdened with a pitful fate in ancient times and during the Middle Ages. There was no effective treatment, healthy citizens showed little compassion, hunchbacks were said to have a vile and base character, and they were usually stigmatised outsiders. The sociopsychological situation for these patients did not improve until modern times, beginning with increased public awareness during the last century, in parallel with the slow development of orthopaedic treatment methods for scoliosis.

Spinal deformity and axial traction.

Axial traction to correct spinal deformity is a very old concept. The oldest reference available is in ancient Hindu mythological epics (written between 3500 BC and 1800 BC) where it is mentioned how Lord Krishna corrected the hunchback of one of his devotees. Later, Hippocrates (460 BC to 377 BC) described certain devices. Galen (131 AD to 201 AD), a follower of Hippocrates, used axial traction with direct pressure. Ibn Sena (980 AD to 1037 AD) in the Middle East also used similar methods. Osteopaths of Turkey also used axial traction to correct spinal deformities. But gradually mechanical methods for the correction of the spinal deformity went into disrepute due to the invariable production of paraplegia. In the past few decades, interest in the correction of spinal deformity has been rejuvenated due to better understanding of anatomy, physiology, and pathomechanics of spinal deformity. Controlled axial traction has been the keystone of several modern procedures such as Cotrel traction, Halo traction, and Harrington Outrigger instrumentation, etc. It appears that the primitive ways of application of axial traction by crude methods did not totally vanish but have been modified. In Indian tribal areas, bone setters still practice it in modified form.