Life and Death in Italian Prehistory: The Case of the Sailor from Spina.

BACKGROUND: There are few reported cases in the literature of spinal injuries from the past, and all of them resulted in the death of the individual or led to severe health consequences. From the historical record, it is well known there were no cures or treatments for spinal lesions in the past. Given the paucity of historical documents focused on this topic, anthropological research on spinal injuries can contribute with important information regarding the medical history of this kind of trauma. Moreover, skeletal trauma and occupational markers may be crucial for the reconstruction of habitual behaviors and the identification of causes and timing of death. We report results of an anthropological study of a case of vertebral injury discovered in an individual from the Italian Iron Age that highlights this important topic. The aim of this study was to assess the habitual activity pattern and manner of death of an ancient inhabitant of Spina in Padanian Etruria (northeastern Italy). METHODS: We performed a detailed anthropological and paleopathological analysis of skeletal remains. RESULTS: The unknown individual was identified as a middle-aged man characterized by a particular trauma to the spine. Lesion analysis revealed a perimortem injury at the L2-L3 level. Characteristic markers on the bones indicated intense physical activity carried out during his life. CONCLUSIONS: This Etruscan, in all likelihood a sailor according to the occupational markers, did not survive a stabbing attack with a bladed weapon.

The Military Medical System and Wartime Injuries to the Spine.

War has historically been a major catalyst for advancement in military medical care and medicine in general. In our current conflicts, advances in battlefield medicine, evacuation techniques, and personal protective equipment have improved survival rates among members of the armed services. With increased survival, there has been increased prevalence of serious but nonfatal injuries, particularly from blunt and penetrating trauma. Blast injuries are the major cause of trauma and have both blunt and penetrating components. With respect to the spine, blasts have led to open, contaminated wounds that are complex and difficult to treat. Additionally, blasts have led to an increased incidence of lower lumbar burst fractures and lumbosacral dissociation. As these and other injuries are being seen more commonly during war, we must ensure that our military medical system is adapting to ensure we are taking care of our military personnel at the highest level.

Spine deformities and trauma in Avicenna's Canon of Medicine.

AIM OF THE STUDY: The purpose of this historic review is to summarize the life and work of Avicenna (980-1037) and his contribution to the diagnosis and treatment of spinal deformities and trauma. METHOD: We conducted an extensive search in libraries as well as online in Pubmed and Google Scholar. RESULTS: Avicenna in his work Canon of Medicine combines the knowledge of ancient Greek and Roman physicians and surgeons and he combines them with the extensive of Arabic medicine and pharmacology. CONCLUSION: Avicenna made an impact with his medical writings in which he summarized the works of ancient Greek and Roman physicians like Hippocrates and Galen with the influence of medieval authors and the knowledge of the Arabic medicine and pharmacology. His descriptions and comments in his work Canon of Medicine summarize and comment the work of his predecessors and it remained a work of reference until at least the sixteenth century.

Serious chronic disease of the cervical spine and trauma in a young female from the middle ages (Czech Republic).

The skeletal remains of the young female (20-24 years) from Grave JP/106, discovered in the Southern Suburb of the Breclav - Pohansko Stronghold (Early Middle Ages, 9th century-beginning of the 10th century, present day Czech Republic) display several noteworthy pathologies. The first is deformation of the mandible, which was most probably caused by a fracture of the ramus in combination with a subcondylar fracture. The spine of this young woman also exhibits a probable traumatic injury of the cervical spine in combination with a slowly growing structure situated inside the spinal canal, which caused deformation centered upon C7. The cervical and thoracic spine together with internal surfaces of several ribs exhibit infectious changes of advanced stage, in all likelihood of tuberculous origin, but osteomyelitis cannot be excluded. Histological analysis of the new bone formation in the ribs confirmed infectious origin, as does Micro CT of C5 and C6. Analyses conducted by two different departments with different methods (PCR amplification of 123 bp long section from IS6110 and Next Generation shotgun sequencing) failed to identify DNA of Mycobacterium tuberculosis from the first rib.

George Riddoch (1888-1947): the driving force behind the treatment of spinal injuries in the UK during the Second World War.

The development of the successful treatment of spinal injuries has been inextricably linked to Sir Ludwig Guttmann and Stoke Mandeville Hospital. The role of George Riddoch has largely been ignored or mentioned merely in relation to Ludwig Guttmann and his appointment as the first Resident Medical Officer at Stoke Mandeville Hospital. Riddoch's contribution was far more significant. New material, comprising Riddoch's letters and memoranda written between 1939 and 1944, reveals his paramount involvement in the setting up of spinal injury units across the UK between 1941 and 1944, and his skill as an administrator and a clinician. Riddoch must be given credit for finding and appointing Ludwig Guttmann.

Treatment of Gunshot Wounds to Spine During Late 19th Century.

BACKGROUND: The demand for neurosurgical procedures increased drastically in the late 19th century owing to advances in ballistics during the American Civil War and Crimean War. METHODS AND RESULTS: Surgical care for a gunshot wound to the spine relied on skilled identification and removal of the fractured bone. Hemorrhage control and infection prevention were also imperative for improving survival rates. CONCLUSIONS: Although new techniques were implemented, the mortality rate from spinal injuries during this period was staggering. Nevertheless, those 19th century procedural methods provided the basis for present-day treatment for spinal injury patients.

Injuries of the spine and of the spinal cord in the Hippocratic Corpus of medicine.

The purpose of this review article is to summarize the views presented in the Hippocratic Corpus of Medicine regarding injuries of the spine, their effect on the spinal cord and the optimal treatment modulus. It is shown that the treatment dilemmas of ancient times in these injuries remain modern since Hippocrates suggested that conservative treatment and letting nature take its course is preferable over a devastating surgical treatment if the spinal cord structural integrity is not compromised. There is also a detailed account of the conservative treatment suggested in the Hippocratic Corpus concerning devices and method of closed spinal relocations.

Historical Vignette of Infamous Gunshot Injury to Spine: "An Ailment not to be Treated"?

The increasing prevalence and gloomy socioeconomic consequence of spine injury remain a concern in modern medicine. In this article, we highlight the infamous gunshot spinal injuries of a few eminent personalities across multiple centuries and their sociopolitical impact in context with the evolution of modern medicine. The role of available medicine in these victims was not more than a mere watcher, thus substantiating an infamous quote from ancient literature that describes spine injury as "an ailment not to be treated."

Spinal Traumas and their Treatments According to Avicenna's Canon of Medicine.

Spinal Traumas have been categorized as disabling diseases that cause irretrievable personal and social problems. Having conducted a rather comprehensive diagnosis of the anatomy of the backbone and spinal cord as well as their functions, Avicenna (Ibn Sina, 980-1037) stated the levels and kinds of spinal impairments that are caused by spinal traumas in his great masterpiece Al-Qanun fi al-Tibb (The Canon of Medicine). He also based his treatment process on his etiological diagnosis of such impairments. Avicenna had used the following methods to treat spinal traumas: food and drug therapy and regimental therapies such as massage, phlebotomy, cupping, dry sauna, and surgery. The authors of the present article review the bases of Avicenna's viewpoints regarding spinal traumas and their treatment.

[The future and the past of surgery for the complicated spine trauma].

The state of art of the spine and spinal cord trauma is highlighted. The thorough literature review was performed. Main trends of the spine surgery, both adopted long ago, and new experimental theories were represented. Problems of medical help organization were also stressed.

Ludwig Guttmann (1899-1980), Stoke Mandeville Hospital and the Paralympic Games.

On 27 July 2012 London is hosting the Olympic and the Paralympic Games. The Olympic Games will be attended by 17,000 athletes to be followed by the Paralympic Games with 4200 athletes from 150 countries, participating in 20 different sports. This multicultural event has grown in the last 60 years from a small competition between British and Dutch athletes on the lawns of Stoke Mandeville Hospital in Buckinghamshire. The Paralympic Movement was born out of the vision of Sir Ludwig Guttmann. Before World War II, most paraplegic patients died. Guttmann came to Stoke Mandeville Hospital in 1944 and instituted the modern treatment of spinal injuries which kept paraplegic patients alive. While exercise is an essential part of rehabilitation, developing strength and agility, and a paraplegic patient can only participate in competitive sport when he or she is fully rehabilitated so the sports movement grew out of the successful treatment of paraplegic patients.

Trauma raquimedular: una breve historia en el tiempo / Rachimedullar trauma: a short history

Hay pocas lesiones tan devastadoras que afligen al hombre como las relacionadas con los traumatismos raquimedulares. El impacto psicológico y social enorme para la persona y la sociedad. En el último siglo, ha habido un interés renovado en el estudio del trauma raquimedular con la esperanza de una cura. Es meritorio revisar los esfuerzos de los médicos en siglos anteriores; con esta visión retrospectiva los caminos para el futuro tratamiento son más evidentes. Como en el pasado la integración de la clínica y los adelantos técnicos e innovaciones creará el curso hacia el progreso para el tratamiento de esta enfermedad(AU)

There are few lesions afflicting the man so devastating that those related with the rachimedullar traumatisms. The psychological and social impact is enormous for the person and the society. In the last century, there it had been a renewed interest in studying the rachimedullar trauma hoping for a healing. It is important to review the efforts of the physicians in the anterior centuries; with this retrospective review the ways to the future treatment are more evident. As in the past, the integration between clinics and the scientific advances and innovations will build the course to the progress in treating this disease(AU)

Ambroise Paré and 16th century neurosurgery.

The luminousness of Ambroise Paré, the surgeon-statesman, has withstood the ravages of time as the mark of a man, a hero, a surgeon-par-excellence, and above all, a benevolent philosopher. A self-made individual, his tryst with the art of surgery emanated from the literally non-stop battlefields of 16th century feudal Europe. Although a maverick in the medical world of his times; he rose from the humblest origins to the highest echelons solely as a result of his own genius and diligence. Among his mammoth contributions to the renaissance of surgery, Paré did perform many procedures which we see as neurosurgical, especially in the realms of neurotrauma and paediatric neurosurgery; the present vignette is an attempt to elucidate the same.

Unique paleopathology in a pre-Columbian mummy remnant from Southern Peru--severe cervical rotation trauma with subluxation of the axis as cause of death.

We describe the multidisciplinary findings in a pre-Columbian mummy head from Southern Peru (Cahuachi, Nazca civilisation, radiocarbon dating between 120 and 750 AD) of a mature male individual (40-60 years) with the first two vertebrae attached in pathological position. Accordingly, the atlanto-axial transition (C1/C2) was significantly rotated and dislocated at 38° angle associated with a bulging brownish mass that considerably reduced the spinal canal by circa 60%. Using surface microscopy, endoscopy, high-resolution multi-slice computer tomography, paleohistology and immunohistochemistry, we identified an extensive epidural hematoma of the upper cervical spinal canal-extending into the skull cavity-obviously due to a rupture of the left vertebral artery at its transition between atlas and skull base. There were no signs of fractures of the skull or vertebrae. Histological and immunohistochemical examinations clearly identified dura, brain residues and densely packed corpuscular elements that proved to represent fresh epidural hematoma. Subsequent biochemical analysis provided no evidence for pre-mortal cocaine consumption. Stable isotope analysis, however, revealed significant and repeated changes in the nutrition during his last 9 months, suggesting high mobility. Finally, the significant narrowing of the rotational atlanto-axial dislocation and the epidural hematoma probably caused compression of the spinal cord and the medulla oblongata with subsequent respiratory arrest. In conclusion, we suggest that the man died within a short period of time (probably few minutes) in an upright position with the head rotated rapidly to the right side. In paleopathologic literature, trauma to the upper cervical spine has as yet only very rarely been described, and dislocation of the vertebral bodies has not been presented.

Fusión espinal. Estudio de una serie de 14 pacientes. Hospital Militar 37, Ghana, 2008- 2010 / Spinal fusion. Study of a series of 14 patients. Military Hospital 37. Ghana. 2008-2010

Se realizó un estudio original de una serie de 14 pacientes operados de inestabilidad vertebral, a los cuales se les practicó fusión espinal en el periodo octubre 2008-octubre 2010. Durante el periodo octubre-2008 a octubre-2010 se realizó un estudio prospectivo de intervención a 14 pacientes con el diagnóstico de columna vertebral inestable. A todos se les practicó estudios radiológicos simples pre y postoperatorios, Tomografía Axial Computarizada o Resonancia Magnética Nuclear. Evaluamos elementos del cuadro clínico pre y postoperatorios. El sexo masculino fue el más afectado y alcanzó la mayor representación 78.5 por ciento y el grupo etáreo de mayor representación 21-30 años (50 por ciento). Siendo la inestabilidad cervical la de mayor número de casos fusionados. El abordaje posterior, se practicó en 12 de los pacientes operados (85.7 por ciento). Las causas más frecuentes de inestabilidad las constituyeron las traumáticas. A los pacientes operados se les practicó descompresión de los elementos nerviosos. Se usaron técnicas como: la fijación transpedicular, fusión de las masas laterales, corpectomía y fijación con láminas y tornillos. Los peores resultados se mostraron en la fusión espinal cervical. La mayor incidencia se presentó entre los 21 y 30 años de edad. La etiología traumática las más frecuente, mostrando la columna cervical los peores resultados quirúrgicos(AU)

It was performed an original study of a series of 14 patients surgically treated for vertebral instability and the spinal fusion was practiced to them during the period october 2008- October 2010. During the period october 2008 to October-2010 a prospective study of intervention was performed to 14 patients with the diagnosis of instability in the spinal cord. Pre and post operatives simple radiological studies were practiced to all of them, Axial Computerized Tomography or Magnetic Nuclear Resonance. We evaluated the elements of the pre and post operative clinical manifestations. Male sex was the most affected with 78, 5 percent and the group of age of higher incidence was 21-30 years (50 percent). The cervical instability belonged to the greatest number of fusion cases The posterior management was practiced in 12 of the operated patients (85,7 percent). The most frequent causes of instability were made by traumas. Decompression of the nervous elements was practiced on the operated patients. Techniques like: The trans-pedicle fixing, fusion of the lateral crowds, laminectomy and fixing with plates and screws were used. They showed the worst results in the spinal cervical fusion.The higher incidence was presented in the group of age from 21-30. Male sex was the most affected, traumatic ethiology was the most frequent, showing the cervical cord disorders the worst results(EU)

The Edwin Smith papyrus: a clinical reappraisal of the oldest known document on spinal injuries.

Dating from the seventeenth century B.C: . the Edwin Smith papyrus is a unique treatise containing the oldest known descriptions of signs and symptoms of injuries of the spinal column and spinal cord. Based on a recent "medically based translation" of the Smith papyrus, its enclosed treasures in diagnostic, prognostic and therapeutic reasoning are revisited. Although patient demographics, diagnostic techniques and therapeutic options considerably changed over time, the documented rationale on spinal injuries can still be regarded as the state-of-the-art reasoning for modern clinical practice.