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Variation in the closure of the sacral canal in the skeletal sample from Pompeii, Italy, 79 AD

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Abstract

Closure of the sacral spinal canal is one of the most variable aspects of human anatomy. Frequencies of the fusion of posterior arches of various sacral segments differ widely between populations from various geographical regions and time periods. Some authors report 50% of S 1 posterior arches to be unfused, while others give figures below 2%. It is also debatable whether various degrees of non-closure of posterior sacral arches are pathological or just a normal variation. Lack of uniformity in the methods used by various authors and terminological debates (eg, correct use of spina bifida occulta) complicate the issue even further. We have examined 124 adult sacra (70 males and 54 females) from individuals who died in Pompeii during the 79 AD eruption of Vesuvius. There were four sacra (3%) with a completely open spinal canal. A completely fused canal (S1 to S5 inclusive) was found in 11% of sacra. The most common condition (47%) was when only the posterior arch of S5 was open. The combination of open S5 and S4 was present in another 35%. Opening of the sacral canal reaching from S5 to S3 was present in 4% of individuals. Among all sacra, 8% had unfused posterior arches of S I irrespective of the degree of the spinal canal closure at other levels. No regular significant sexual dimorphism was noted. The sample of sacra from Pompeii seems to fall within the ranges reported for other populations, even with the uncertainties regarding differences in the methods used by various authors. Due to its frequent occurrence in various populations, incomplete closure of the sacral canal can hardly be considered to be a true, disabling pathological condition.
VARIATION IN THE CLOSURE OF THE SACRAL CANAL
IN THE SKELETAL SAMPLE FROM POMPEII, ITALY, 79 AD
RENATA J HENNEBERG and MACIEJ HENNEBERG
Department of Anatomical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia
ABSTRACT
Closure of the sacral spinal canal is one of the most variable aspects of human
anatomy. Frequencies of the fusion of posterior arches of various sacral segments differ
widely between populations from various geographical regions and time periods. Some authors
report 50% of S 1 posterior arches to be unfused, while others give figures below 2%. It is also
debatable whether various degrees of non-closure of posterior sacral arches are pathological
or just a normal variation. Lack of uniformity in the methods used by various authors and
terminological debates (eg, correct use of spina bifida occulta) complicate the issue even
further.
We have examined 124 adult sacra (70 males and 54 females) from individuals who
died in Pompeii during the 79 AD eruption of Vesuvius. There were four sacra (3%) with a
completely open spinal canal. A completely fused canal (S1 to S5 inclusive) was found in
11% of sacra. The most common condition (47%) was when only the posterior arch of S5
was open. The combination of open S5 and S4 was present in another 35%. Opening of the
sacral canal reaching from S5 to S3 was present in 4% of individuals. Among all sacra, 8%
had unfused posterior arches of S I irrespective of the degree of the spinal canal closure at
other levels. No regular significant sexual dimorphism was noted.
The sample of sacra from Pompeii seems to fall within the ranges reported for
other populations, even with the uncertainties regarding differences in the methods used by
various authors. Due to its frequent occurrence in various populations, incomplete closure of
the sacral canal can hardly be considered to be a true, disabling pathological condition.
Key words: sacrum, spina bifιda occulta, anatomical variation
INTRODUCTION
Anatomical variations of the vertebral posterior arches and posterior segments of the
sacrum were studied previously in archaeological human skeletal series (Stewart, 1932;
Ferembach, 1963; Post, 1966; Bennett, 1972; Suzuki, 1978; Bradtmiller, 1984; Webb, 1995).
A commonly observed condition was the lack of fusion of the posterior arches of the lower
lumbar vertebrae and of the posterior arches of the sacrum. This condition was referred to as
spina bifida occulta.
In the sacrum various researchers used the term spina bifιda occulta to describe different
degrees of open and closed posterior arches. Some authors used spina bifida occulta
exclusively to describe the completely open dorsal part of the sacral spinal canal (Webb.
1995); others used this term when the sacral spinal canal was open from S3 upwards
(Bradtmiller, 1984). Some researchers classified spina bifida occuιlta into two types, complete
and incomplete spina bifιda occulta. without defining which posterior arches were open in the
incomplete type (Suzuki, 1978; Macchiarelli, 1989). Some authors used the term 'neural tube
178 Renata Henneberg and Maciej Henneberg
closure failure' indiscriminately to describe all variants (regardless of the defects or the normal
variation), including a complete opening of the sacrum and a single posterior arch opening at
S5 (Devor and Cordell, 1981).
Despite many published reports on spina bifida occulta, from both historical and modern
skeletal collections, it is difficult to compare frequencies of spina bifιda occulta across
populations and through time. The concern about the lack of a clear definition of spina bifιda
occulta in the sacrum for use in comparative skeletal studies has also been expressed by
previous researchers (Ferembach, 1963; Ortner and Putschar, 1985; Webb, 1995). Most of
the morphological studies of spina bifιda occulta in skeletal series and in various populations
were conducted from the early part of this century up until the 1970s.
Post (1966), in his attempt to classify the vertebral variations of the spine, did not
specify at which level the opening of the sacral canal is still considered normal; instead he
described variations at a level of each sacral vertebra. In the majority of recent studies, the
term spina bifιda occulta in the sacrum was used to denote a failure to close the arches of the
first and sometimes also the second sacral segment, or a complete failure to close the entire
sacral spinal canal (Boone et al, 1985; Fidas et al, 1987; Saluja, 1988; Avrahami et al, 1994;
Webb, 1995). The non-closure of the last three sacral segments (3rd, 4th and 5th) was
considered a normal variation (Romanes, 1981).
In clinical publications, spina bifιda occulta is described as a minor abnormality in the
closure of the spinal canal which is covered only by soft tissues without bone being involved.
In its uncomplicated form only one vertebral arch fails to close. Sometimes more than one
vertebral arch is involved and widening of the spinal canal occurs. Further complications then
follow, such as lipoma, dermatological and neurological lesions (Elwood et al, 1992). The
condition occurs most frequently in the lumbosacral region (James and Lassman, 1981). The
defects of the closure of the spinal canal, including spina bifιda occulta, are heritable and most
probably controlled polygenically (Ricardi, 1977; Elwood et al, 1992).
Until recently in medical practice spina bifιda occulta was seen as a common condition
with little clinical significance, in contrast to more severe malformations such as
meningocoele or myelomeningocoele (Lorber and Levick, 1967; Boone et al, 1985; Elwood et
al, 1992). Renewed interest in the studies of the spina bifιda occulta condition in the
lumbosacral region has been observed recently, because the defect was found to be associated
with lower back pain, posterior disc herniation, urodynamic problems and other abnormalities
of the lower urinary tract (Avrahami et al, 1994; Galloway and Tainsh, 1985; Fidas, 1987;
Fidas et al, 1989).
Family studies revealed a high incidence of spina bifιda occulta among parents of
children with other more severe forms of neural tube defects, although the results of such
studies are not always in concordance with each other (Vannier et al, 1981; Carsin et al, 1986;
Saluja, 1988; Elwood et al, 1992). There were also studies reporting increased incidence of
spina bifida occulta in areas with high levels of fluoride in the drinking water (Gupta et al,
1995).
Some recent publications suggest a decrease in more serious neural tube defects in some
populations in the last few decades (Owens et al, 1981; Danks and Halliday, 1983; Carstairs
and Cole, 1984; Lorber and Ward, 1985), while other studies report increased frequency of
spina bifida occulta during the same time (Boone et al, 1985; Fidas et al, 1987; Avrahani et al,
1994). Very few researchers have attempted comparisons between contemporary and
historical samples from, presumably, the same population. In the only such study known to
the authors, Saluja (1988) compared the radiographs of a sample of modem people from
London with the 18th-19th century skeletal sample from one of the church crypts in London.
The Sacral Canal Closure in Ancient Pompeii, 79ÁD 179
and did not find any secular trend in the frequency of spina bifida occulta over the two
centuries.
In view of these new findings, new questions have arisen, as well as the need for more
data to answer them. The need for more data on the frequency of spina bifιda occulta in
present populations, in clinical context, and also in past populations has already been
expressed by some authors (Saluja, 1988; Elwood et al, 1992).
The purpose of the present study was threefold: 1) to present some new data from
antiquity; 2) to argue for a unified system to collect data on the sacral spinal canal variation,
and to define spina bifιda occulta based on both anatomical and clinical findings; and 3) to
contribute to the debate regarding secular trends in spina bifida occulta.
MATERIALS AND METHODS
The skeletal sample from Pompeii examined in this study has certain unique
characteristics. Firstly, the direct cause of death was known for the entire sample: it was a
mass disaster caused by the volcanic eruption of Vesuvius in August 79 AD. This direct cause
of death seems to be unrelated to any specific diseases. Secondly, it is known that drinking
water in ancient Pompeii and in areas surrounding Vesuvius contained high levels of fluoride.
This fact has been confirmed recently by Torino et al (1995) for a sample of teeth from
ancient Herculaneum, which was destroyed by the same volcanic eruption as Pompeii. Torino
and co-workers found very high levels of fluoride in the tooth enamel of individuals from
Herculaneum, about 14 km from Pompeii.
The sample in this study consists of 124 adult sacra of 70 males and 54 females. The
sacra were examined macroscopically by both authors. Chi-squared tests were used for
comparisons of the results and their statistical evaluation.
The majority of sacra belonged to the skeletons excavated during the 19th century in
various parts of Pompeii. Some skeletons were lying on the streets, some inside various
buildings. Five sacra belonged to the occupants of the house of C Iulius Polybius, excavated
during the 1970s. The skeletal material excavated in the 19th century was segregated earlier
according to the type of bone; in most cases, at the time of our study, it was difficult to
reassemble individuals. The skeletons from the house of C Iulius Polybius were reassembled
by M Henneberg during a previous study conducted on this sample (Henneberg et al, 1996).
Except for the sacra from the house of C Iulius Polybius, where various methods of
establishing the sex of an individual could be applied, sex was established according to the
morphological sex differences of the sacrum, using methods described by Kimura (1982) and
Krogman and Iscan (1986).
In our investigation, we adopted the recent definition of the term spina bifιda occulta, as
used in clinical studies and practice. Spina bifτda occulta of the sacrum denotes the variation
in the anatomy of the sacrum where at least the posterior arch of the first sacral segment
failed to fuse. The posterior arches of the other sacral segments can be fused or open,
including the variation where the entire dorsal side of the sacral spinal canal is completely
open. This description is dictated by the anatomy of the spinal cord, where its conus in
normal conditions does not descend below the level of L3, and by clinical findings which
suggest that about two-thirds of the complications which impact on an individual's health,
such as laminal defects and spinal cord anomalies, are associated with non-fusion of the
posterior arches at the lumbosacral joint, mostly at the level L3-Sl. Only about 10% of neural
tissue defects are associated with the S2-S5 area of the sacrum (James and Lassman, 1981).
180 Renata Henneberg and
Maciej
Henneberg
The Sacral Canal Closure in Ancient Pompeii, 79AD 181
In order to unify data collection on skeletal material and for purposes of
comparative studies, we used a simple system of recording variations in the posterior
sacral canal for each of the sacral segments in two categories: open or closed. The term
spina bifida occulta in the sacrum was used only when at least SI was open. Other
variants of spina bifιda occulta in the sacrum occur when the spinal canal in the dorsal
sacral part is open from SI downwards to S5, including the completely open spinal
canal. Anatomical forms of hiatus sacralis, where the dorsal part of the sacral canal
opens from S5 up to S2 while at the same time the fusion of posterior arches at the level
of S1 is evident, are considered normal variations. This system of recording anatomical
sacral variations is simpler than the one of Post (1966) because it does not include
variations where the opening is half way into the sacral vertebrae. We also suggest the
clinical application of the term spina bifida occulta to skeletal findings for reasons
explained above.
RESULTS
Examples of the spina bifida occulta found in Pompeii and some of the normal
variations are presented in Figure 1.
In total, there was 11% of spina bifida occulta in the sample from Pompeii. Only
3% of the sacra had all arches open completely. An additional 8% of the sacra had open
arches of the first sacral segment while some other arches were closed normally.
The opposite sides of the posterior arch of S5 were not fused in 82% of sacra. The
most common variation (47%) was when only S5 was open and the other posterior
arches were closed. The combination of posterior part of S5 and S4 open followed as
the second most common variation (36%); however, the difference between the
frequency of these two variations is not statistically significant. Only 4% of sacra had
S5, S4 and S3 simultaneously open. A completely closed posterior sacral canal was
found in 11% of sacra (Tables 1 and 2).
There was no statistically significant difference between sexes in most of the
variants, including spina bifιda occulta. The only statistically significant difference
between females and males was found in the
fr
equency of sacra with only S5 open.
Among males 36% had this variant as opposed to
61%
of females.
182 Renata Henneberg and Maciej Henneberg
Other variations found in this sample included sacralisation of L5 (19%) and sacralisation
of coccygeal Col (7%). Sacralisation of L5 occurred more often among males (23%) than
females (13%), but the difference was not statistically significant. Sacralisation of the coccyx
also occurred more frequently in male (11%) than in female sacra (2%), but the difference, as
for the sacralisation of L5, was not statistically significant.
Within the group of sacralised L5 there were further variations observed. Asymmetrical
fusion of L5 to the sacrum was found in two cases (1 female and 1 male). Sacralisation of this
female L5 occurred only on the right side while the left side was free. In the male case, L5
was fused with the sacrum on the left side but not on the right side. In another male sacrum,
massae laterales were fused with L5 bilaterally, but disk space remained. One male sacrum
exhibited sacralised Col-Co3. The same male also had L5 completely sacralised and only S5
open. In one male with spina bifida occulta where SI arch was open, L5 was completely
sacralised and also open (spina bífιda occulta at L5-S1). In one female compression of S3 was
observed. Some of the sacra showed arthritic changes, but osteophytes were found only in
one female case with only S5 open.
Only the most frequent and very rare variations have been described above. Frequencies
of major variations in the posterior sacral canal closure and frequencies of some more
common anomalies are shown in Table 1.
The frequency of spina bifιda occulta in Pompeii falls in the middle of results reported
from other archaeological samples (Table 3). It is lower than the frequencies for ancient
Egyptians and the Anglo-Saxons from the 10th century AD, but higher than those found
among the ancient Peruvians and Aleuts. Our results are similar to those obtained for the
Romano-British and Anglo-Saxons of the 6th-7th century AD. Results for Pompeii are
The Sacral Canal Closure in Ancient Pompeii, 79AD 183
intermediate to those reported for most of the modern populations where similar criteria were
applied to assess the frequency of this anomaly (Table 3).
The frequency of what is considered the normal variants of the non-closure of the posterior
sacral arches in adults from Pompeii was also similar to frequencies reported in the literature.
Sacra with only the fifth arch open and the rest closed were the most common variant, closely
followed by sacra with the fifth and the fourth arches open. In most reports, for various
populations, about one-tenth of the sacra studied had all five arches completely closed (Tables 1
and 4).
DISCUSSION
Our results do not suggest any specific or strong factors influencing the frequency of spina
bifida occulta among ancient Pompeian. Post in 1966 compared results of studies on various
populations and concluded that the so-called 'civilised' populations have higher frequencies of
spina bifida occulta than the so-called 'non-civilised' ones. He described 'civilised' populations
as those with a longer recorded history, such as ancient Egyptians. He suggested that
technological advancement resulted in the relaxation of natural selection and hence increased the
amounts of variation. His suggestions of secular trend and its causes. however, are very general
and are still under investigation.
The decrease of more serious neural tube defects (anencephaly and spina bifida cystica)
has been attributed to preventive measures, such as periconceptional vitamin supplementation
(Smithells et a1, 1981), screening programs, and termination of pregnancies with neural tube
defects. At the same time, in the same populations, the increase of minor defects such as spina
bifida occulta among younger adults in comparison with older people is suggested to be an effect
of ageing, where degenerative processes can lead to new bone formation (Boone et al, 1985).
Fluctuations in the prevalence of spina bifida occulta has been found in Jamaica, where
routine pelvic radiographs were examined and analysed in four age groups. The steady
184 Renata Henneberg and Maciej Henneberg
increase in spina bifida occulta was observed between people over 35 years old and those of 24-
34 years and 15-24 years old (both sexes). The oldest group of males (55-64 years) had a higher
prevalence of spina bίfida occulta than people of the two other older age groups. This deviation
from the trend was interpreted as some unspecified environmental factors influencing that
particular male age group (Lawrence, 1977).
Environmental influences are implicated in the decrease of neural tube defects (NTDs)
because the decrease in NTDs is greater in areas where their prevalence was high (Seller, 1987). In
some countries, like the Republic of Ireland, the rapid decrease in neural tube defects occurred
despite a lack of screening programs and no pregnancy termination. It is also argued that overall
better living conditions, better diet and vitamin supplementation in some countries showing
decreased frequencies of neural tube defects are not sufficient environmental factors to explain the
trend and its velocity (Seller, 1987). This dramatic decline in NTDs was also observed in
circumstances where the presence of long term, massive unemployment and a deteriorating social
climate would not suggest improved living conditions, for example in Sheffield (Lorber and Ward,
1985) and Paisley (Shepherd, 1983).
In Sheffield, a drop in NTDs occurred at the same time an increase in other congenital
defects was reported (Lorber and Ward, 1985). On the other hand, an increase in neural tube
defects was found in Jamaica after hurricane Gilbert in 1988, and 'post disaster nutritional scarcity'
was suggested as a factor influencing the trend (Duff et al, 1991).
Interesting changes in the prevalence of NTDs were observed in Hungary, where initially a
decrease was observed, then stabilisation of the trend occurred, followed by a slight increase in
neural tube defects (Czeizel, 1983). In South America, Castilla and Orioli (1985) observed no
changes in the prevalence of neural tube defects over a 12 year period. According to these authors
if a real decrease occurred in the prevalence of NTDs, it was counter-balanced by better recording
systems in hospitals. Most South American countries belong to the group of countries with a low
incidence of neural tube defects.
From the results presented above it is not clear what causes the decline of more serious
neural tube malformations and the increase of minor defects such as spina bifida occulta.
Specific factors, like vitamin supplementation, are the more likely causes of frequency changes, in
contrast to more general factors like improving living conditions or even better quality medical
services. Experimental studies on mice showed that vitamin B6 and vitamin B 12 significantly
reduced valproic acid induced teratogenesis, including a significant 80% reduction in spina bifida
occulta (Elmazar et al, 1992). The higher incidence of neural tube defects, including spina bifida
occulta, and their increase over time in areas with a high fluoride content in drinking water or in
areas with agricultural poisoning (artificial substances) supports the hypothesis of specific
environmental factors influencing changes in the prevalence of NTDs (White et al, 1988; Gupta,
1995).
Our results from ancient Pompeii do not suggest that the increased fluoride content in
drinking water in the city triggered the higher frequency of spina bifτda occulta among its
inhabitants. The frequency of this abnormality in Pompeii was similar to, or lower than,-many of the
results from other skeletal series (Tables 3 and 5). It has to be pointed out, however, that in most
skeletal studies factors which could have an influence on the frequency of spina bifida occulta
are unknown. The high frequency of this anomaly found in some archaeological samples is most
commonly interpreted as an indicator of inbreeding and genetic isolation (Ferembach, 1963;
Bennett, 1972; Macchiarelli, 1989).
Studies of consanguinity and the frequency of neural tube defects in living populations
where marriages between relatives are common practice indicate a higher frequency of such
defects compared to populations where marriages between relatives are rare (Kulkarni et al,
The Sacral Canal Closure in Ancient Pompeii, 79AD 185
1989). If consanguinity is low in the population its general effect on the frequency of
neural tube defects will probably be small (Elwood et al, 1992:683-686). There is no
reason to expect high levels of inbreeding in a trading city like Pompeii, and
accordingly, our results from Pompeii do not show any striking difference from past
populations where inbreeding has not been suspected (Table 5).
The most recent findings on living people point towards a rapid secular increase in
spina bifida occulta among Europeans and Israelis during the 20th century. In contrast to
the last few decades of the 20th century, no secular trend in the frequency of spina bifida
occulta has been found between 18th-19th century and modem populations from London
(Saluja, 1988).
Lack of sufficient data on the modem population of Pompeii restricts us to
comparisons between the results from ancient Pompeii and other modern Italian or
European populations. There are, however, very few published data available to us for
Italian populations which can be used for comparison. Agostini et a1 (1991) published
data for a control group of 264 Italians in which the frequency of spina bifida occulta was
around 25%, in contrast to a group of patients with testicular cancer where the frequency
of this anomaly was 45%. The results for the control group are more than twice that for
the sample from Pompeii (11% including completely open sacral canal) suggesting the
presence of a secular trend among Italians. Unfortunately the control group in Agostiní's
et al (1991) research were patients with radiographs taken mainly for back pain, and in
view of the association of spina bifida occulta with lower back pain (Avrahami, 1994),
this group cannot be used by us as an unbiased representation of the Italian population.
It should be remembered that information on the involvement of soft tissues is
missing from any archaeological skeletal material. Some less severe forms of neural tube
defects in the sacral region may manifest themselves in soft tissues as well as, to a lesser
degree, in bony defects, thus giving incomplete information. On the other hand, the
failure to close the posterior arches of sacral vertebrae is not necessarily associated with
any developmental defects of soft tissues or with causing further health problems
(Elwood et a1, 1992). To answer these more detailed questions regarding the proportion of
various degrees of soft tissue involvement and its relation to neural tube defects, studies
of cadaver collections and living people are needed to supplement the skeletal
observations.
The skeletal sample from Pompeii, theoretically, should reflect the demographic
structure of the living population at the time of the volcanic eruption, when people died
indiscriminately in a few days time, generally from suffocation (Henneberg et al, 1996;
186 Renata Henneberg and Maciej Henneberg
Henneberg and Henneberg, n.d.). It is then possible to compare the results from Pompeii with other
living populations, but with caution. In each of their studies Fidas et al (1987) for Edinburgh and
Glasgow, Boone et al (1985) for England, and Avrahami et al (1994) for Israel reported frequencies of
spina bifida occulta among adults at a frequency of at least twice as high as the frequency found in
Pompeii (Table 6). The same authors observed a rapid secular trend in the frequency of spina bifida
occulta within each of the studied populations in the last few decades of the present century. They
found a statistically significant increase of this anomaly among younger adults compared with older
age groups. Compared with these modern populations, the results for Pompeii are lower with regards to
the results for the older groups of 30-70+ years and statistically significantly lower than for the
youngest adult groups (Table 6). The average age of adults who died in Pompeii is lower than the
modern populations (Henneberg and Henneberg, n.d.) and is obviously lower than the 30-70+ years
group. The difference between the results for Pompeii and the modern samples could be even greater if
the possibility of progressive closure of the sacral canal with age and ageing is considered (Boone et
al, 1985; Fidas et al, 1987).
Saluja (1988), in his investigations of the 18th-19th century London skeletal sample from the
crypt of St Bride's Church and the present day sample from London, did not find any secular trend in
the frequency of spina bifida occulta. His results should also be treated with caution, because
archaeological samples from burial places used for many decades or centuries, such as a church
crypt, may not have the same demographic qualities as a cross-section of the living population or a
population from a mass disaster such as Pompeii.
In order to confirm or deny the presence of a secular trend in Italy, or in Pompeii in particular,
ideally, the results for a random sample of adult Pompeians would be needed. although they are
difficult to obtain at the moment. It is known from previous research on neural tube defects,
including spina bifida occulta, that frequencies of such defects differ geographically (Sarin et al,
1981; Castilla and Orioli, 1985; Seller, 1987; Kulkarni et al, 1989; Elwood et al, 1992), thus the
direct comparisons of frequencies between even closely related populations (geographically and
historically) will not be possible.
The Sacral Canal Closure in Ancient Pompeii, 79AD 187
From the existing data, however, it may be suggested that at least in Western Europe there is
a positive secular trend in the frequency of spina bifida occulta, observed especially in the last
century. The subject of secular trends requires further studies on a broader range of populations,
historical as well as living, and if possible on larger and well dated archaeological skeletal samples.
ACKNOWLEDGEMENTS
The authors are most grateful to Professor PG Guzzo, the Superintendent of Pompeii, and Dr
Annamaria Ciarallo, the scientific programme co-ordinator for Pompeii, for their permission to study the
skeletal material.
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... Dj00 B 81/10 sacral hiatus only affects the fifth sacral vertebra and has a typical inverted BV^shape (Seema and Mahajan 2013; Fig. 4). Closure of the sacral spinal canal is one of the most variable aspects of human anatomy (Henneberg and Henneberg 1999), and the extension of non-closure of the lamina of the sacral bodies is variable (Albrecht et al. 2007). The presence of an open sacral midline is highly frequent at S5 and S4 level and, although not so much, at S3 level (Fidas et al. 1989;Henneberg and Henneberg 1999;Nagar 2004;Armstrong et al. 2013). ...
... Closure of the sacral spinal canal is one of the most variable aspects of human anatomy (Henneberg and Henneberg 1999), and the extension of non-closure of the lamina of the sacral bodies is variable (Albrecht et al. 2007). The presence of an open sacral midline is highly frequent at S5 and S4 level and, although not so much, at S3 level (Fidas et al. 1989;Henneberg and Henneberg 1999;Nagar 2004;Armstrong et al. 2013). Some authors claim that hiatus sacralis or sacral hiatus should not be considered pathological but as a normal variation (Henneberg and Henneberg 1999;Kumar and Tubbs 2011). ...
... The presence of an open sacral midline is highly frequent at S5 and S4 level and, although not so much, at S3 level (Fidas et al. 1989;Henneberg and Henneberg 1999;Nagar 2004;Armstrong et al. 2013). Some authors claim that hiatus sacralis or sacral hiatus should not be considered pathological but as a normal variation (Henneberg and Henneberg 1999;Kumar and Tubbs 2011). However, as Kumar and Tubbs (2011, p. 28) highlighted, Bfrom the perspective of identification of dysraphisms, all cases of spina bifida, irrespective of the level of occurrence on the vertebral column, should be recorded.^In ...
Article
Spina bifida is a neurulation defect that results in an incomplete closing of the backbone, as well as membranes surrounding the spinal cord. Several archaeological cases of spina bifida have been reported, remarkably during the Bronze Age and Classic Era. However, few prehistoric cases have been recovered, with the exception of the important Epipaleolithic Iberomaurusian site of Taforalt (Morocco). This article describes the first case of a spina bifida condition during the Neolithic of Near East, at the Syrian site of Dja-de el-Mughara. Although at the onset of the Syrian civil war, image record has enabled the description of a complete spina bifida case. Two other possible cases have not been confirmed, since it was impossible to reevaluate the osteological material hosted at the field laboratory in Dja-de el-Mughara. However, due to the low incidence of this neural tube disorder (NTD), we argue that it could be associated to a genetic disorder rather than to environmental factors such as arsenic intake or a deficient diet.
... This investigation will serve to challenge the assumption that reduced health is attributed to lower class individuals only. The skeletal remains from the eruption site of Pompeii demonstrate evidence of many health issues, including pathogen-causing maladies (e.g., brucellosis), and metabolic conditions (e.g., fluorosis) (Henneberg & Henneberg, 1999Lazer, 2009). Based on well-preserved food remains and ancient documentation of diet of the elite class, I will argue that members of higher socioeconomic status in ancient Pompeii were at an increased risk of developing specific illnesses and diseases because of their associated diet. ...
... While every individual at Pompeii would have been at risk for fluoride overexposure, the elite, who had the most access to marine wildlife, would have been at a higher risk for increased fluoride exposure. Fluoride exposure has also been attributed to increased risk of spina bifida occulta, which has been documented in the skeletal remains found at Pompeii (Henneberg & Henneberg, 1999;Lazer, 2009). ...
... This family also demonstrated spina bifida occulta in the remains of an adult female and the female child (Henneberg & Henneberg, 1999). Based on the previous identification of risks associated with spina bifida occulta, this family may have been of a higher socioeconomic class. ...
Article
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This investigation challenges the assumption that reduced health is attributed to lower class individuals only. Skeletal indicators of illness and disease found on the osteological remains at ancient Pompeii are associated with an elite diet. The chronic conditions include dental caries, brucellosis, dental abrasion, dental abscesses, fluorosis, Forestier’s Disease (DISH), Hyperostosis Frontalis Interna (HFI), spina bifida occulta, and tuberculosis. The volcanic eruption in 79 CE provided exceptional preservation of the remains of flora, fauna, artwork, and architecture, which are used to recreate the diet and lifestyle of members of Pompeian society. Past analyses of the osteological remains include the disarticulated skeletal elements in the bath complexes and the burial of a large family within a dwelling at Pompeii. These remains are representative of a sample of the living population and contain paleopathological markers that are attributed to the consumption of food items specific to an elite diet. This case study demonstrates another avenue of research within the ecological-political model in archaeological context and illustrates many health risks associated with the lifestyle of members of higher socioeconomic status.
... The significant age and sex differences in the Dakhleh sample are concordant with modern and bioarchaeological results. The regressive age trend is virtually universal (Fidas et al., 1987;Kumar and Tubbs, 2011;Eubanks and Cheruvu, 2009), whereas the sex differences are more variable (Kumar and Tubbs, 2011;Henneberg and Henneberg, 1999), though in studies with large sample sizes the prevalence is generally significantly higher in males (Fidas et al., 1987;Eubanks and Cheruvu, 2009). The variant results in modern studies with small sample sizes (see Kumar and Tubbs, 2011) are possibly due to sampling error. ...
Article
Objective: To document sacral spina bifida occulta (SSB0) prevalence in a population sample from the Dakhleh Oasis, Egypt, and address methodological issues in recording and quantifying SSBO variations. Materials: 442 adult sacra from two temporally disjunct samples from the same deme traversing the 3rd intermediate (TIP) and the Roman Periods. Methods: Sacra were scored for SSBO, excluding the sacral hiatus. Risk of SSBO was calculated with the common odds ratio and statistical significance by X 2. Data were compared to other archaeological SSBO data. Results: SSBO was present in 15.6% of the sample with a slight, but not significant, temporal increase (TIP to Roman Period) in males, and a significant age-correlated increase in both sexes. Most open sacra occurred in young adults. Conclusions: Data support that SSBO can be considered as a morphogenetic variant. Dakhleh data fall within the prevalence range for most populations, however inter-population comparisons are complicated by methodolo-gical inconsistencies. Significance: SSBO can be used in paleogenetic research. Limitations: Methodological differences in scoring SSBO prevent effective comparative study. Suggested future research: Future studies require more rigorous and standardized scoring methods. aDNA may be used to corroborate the morphogenetic value of SSBO and determine its clinical significance.
... Ortner and Putshar, 1985;Aufderheide and Rodríguez-Martín, 1998;Mays, 2006;and Kuma and Tubbs, 2011), deformations of the axial skeleton (e.g. Porter and Park, 1982;Henneberg and Henneberg, 1999;, abnormal cranial suture development (e.g. Barnes, 1994;and Roberts and Manchester, 2010), spondylolysis (e.g. ...
Thesis
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Skeletal variants are often used by biological anthropologists in the study of human variation. Some skeletal variants are affected by environmental factors, especially those related to physical activities whereas others are genetic in origin. Such genetic variants have long been used to support the hypotheses on the history and divergence of human populations suggesting that some population groups can be genetically distinguished. However, when genetic traits occur in higher than expected frequency, such skeletal variants can be interpreted as possible indicators of relatedness. This study reviews the frequency of 126 cranial and postcranial skeletal variants within the Medieval Poulton Chapel, St. Owen’s Church and Norton Priory Collections, U.K. These traits were examined to determine; 1) the prevalence, 2) whether there are significant differences between the sexes and/or by age category and, 3) if there are mechanical differences between the samples, with means for distinguishing between rural and urban populations and/or by social segregation. Finally, the spatial distributions of skeletal variants within the burial ground of Poulton Chapel were explored to determine possible familiar relationships. This thesis has demonstrated the frequency and variance of 126 skeletal variants and, significant differences were reported between the sexes and by age-at-death for each site, however, the skeletal variants presenting such differences differed between the three sites. Some significant differences were apparent for skeletal variants influenced by mechanical/physical activity for each sample although the results are not definitive in establishing occupational divides between the rural Poulton Chapel and the urban St. Owen’s Church Collections, or as a social divide to the monastic Norton Priory Collection. Interestingly, Poulton Chapel and Norton Priory share 60 skeletal variants while St. Owen’s Church only shares seven traits with Norton Priory and just three with the Poulton Chapel sample. This suggests a likely geographical north-south divide between these three sites. Unfortunately, the burial spatial analysis at Poulton Chapel is inconclusive. However, the value of the vertebral skeletal variants as a proxy for determining familiar relationships should be raised and used for future research.
... Under the neurulation classification system used in this study and in clinical studies, even the nonfusion of S4 and S5 represents a defect that should be considered among a population with the entire spectrum of vertebral involvement, particularly in a population where more severe vertebral involvement is observed, such as at Canimar Abajo (Greene and Copp, 2006). The inclusion of mild defects may be considered to inflate the frequency of SB at the site, but Canimar SB numbers are still high compared to other reported archeological frequencies (Henneberg and Henneberg, 1999). Of the 14 SB-sacra at Canimar, four can be said to have 'severe' sacral involvement (non-fusion of S1/2-S5), three have mid-range involvement (non-fusion of S3-S5), while the remaining seven have milder involvement, (non-fusion of S4 and S5). ...
... This error results in dorsal nonunion of the vertebral laminae. 9 SBO can occur at any level of the spinal column but is most common in the lumbosacral region, especially from L3 to S1. 3 Lower sacral spina bifida is one of the most common forms of SBO and is often characterized as an anatomic variant instead of as a pathological condition. It is typically thought of as a minor defect and is often not even mentioned by the radiologist when lumbosacral radiographs are interpreted. ...
Article
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Spina bifida occulta is found in 10-30% of the population, and most commonly occurs at L5. Such bony malunions are usually asymptomatic but rarely may be associated with neurological sequelae. Most rare is complete spina bifida of the sacrum. The authors discuss the characteristics of and potential clinical and surgical issues arising from this dysembryology, and two cases of complete malunion of the posterior elements of the sacrum.
... Kapalı spina bifida türlerinden biri olan sacral spina bifida occulta (SSBO), omurilik ve meninksleri etkilemeden posterior vertebral elemanlar arasındaki kaynaşma yetersizliği sebebiyle oluşur [6,14] Literatürde SSBO'lu kabul edilen sakrumların açıklık dereceleri farklılık gösterdiği için [3,5,17], karmaşaya yol açmamak adına bu çalışmada yalnızca posterior bölgeleri tamamen açık (S1 -S5) olan sakrumlar değerlendirmeye katılmıştır. ...
Poster
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Amaç: Spina bifida, vertebral arkın bir kısmının ya da tamamının kapanmaması durumudur. Bu çalışmada; Milas Belentepe Doğu Roma - Bizans toplumunda görülen ve bir spina bifida türü olan sacral spina bifida occulta (SBO) patolojisi incelenmiştir. Bu inceleme sonucunda belirlenen bu patolojik olgunun ilgili toplumda görülme sıklığı belirlenerek, daha önce çalışılmış olan Kyzikos toplumu ve Doğu Anadolu’daki güncel bir çalışma ile karşılaştırılmıştır. Bu çalışmadaki amacımız, SBO’nun Anadolu’nun farklı iki bölgesindeki indisansını karşılaştırmak ve bu patolojinin muhtemel sebeplerine değinmektir. Gereç-Yöntem: Bu çalışmada, Milas Belentepe alanında 2011-2013 kazı sezonu boyunca ortaya çıkarılmış Doğu Roma Bizans dönemine ait 158 bireyin sakrumları yıkanıp kurutulduktan sonra incelenmiş ve bu bireylerin epifizleri tamamen kaynaşmış olanları değerlendirmeye katılmıştır. Yani yalnızca genç erişkin/erişkin bireylerin sakrumları değerlendirmeye tâbi tutulmuştur, bu yüzden 72 birey çalışılmıştır. Bireylerin yaşları ve cinsiyetleri iskeletin korunma durumuna göre, mevcut antropolojik yöntemlerden en uygun olanları seçilerek belirlenmiştir. Bulgular: İncelenen 72 sakrumun sadece iki tanesinde SBO patolojisine rastlanmıştır. BLT11-M116 numaralı ve BLT13-M90 numaralı bu iki birey de erişkin erkek olarak belirlenmiştir. Buna göre bu patolojik olgunun popülasyon içerisinde bulunma sıklığı %2,77’dir. Sonuç: SBO’nun etiyolojisi kesin olarak bilinmemekle birlikte, oluşumunda genetik ve çevresel etmenlerin birlikte rol aldığı, bu konuyla ilgili yapılan güncel araştırmalarda rapor edilmektedir. Konuyla ilgili yapılan araştırmalarda SBO’nun, gebeliğin ilk haftalarında oluştuğu ve folik asit (vitamin B9) eksikliğinin bu hastalığa neden olduğu literatürde açıkça ortaya konulmuştur. Folik asit, bitkisel ve hayvansal besinlerin birçoğunda bulunmaktadır. Çalışma kapsamındaki 72 bireyde yapılan değerlendirmede ortaya çıkan insidansın %2,77 gibi düşük bir oran olmasının sebebi, folik asit alımının, dolayısıyla beslenmenin bu toplumda nispeten iyi olmasından kaynaklanabilir. Çünkü bölgenin coğrafi yapısı gereği, folik asit açısından zengin ürünlerin bulunduğu bilinmektedir. Bir yandan bebek ve çocuk nüfusunun çalışmaya katılmaması da düşük insidansın sebelerinden biri olarak gösterilebilir. SBO’nun iki erişkin bireydeki varlığı, bize bu patolojinin genetik bir alt yapısının da olduğunu ve toplum içinde bu sebepten görülebildiğini düşündürmektedir. Kyzikos toplumunda 21 bireyin sadece ikisinde (%9,52) SBO görülmüştür. Bu bağlamda Belentepe toplumundaki SBO insidansının, Kyzikos'a göre çok daha düşük görünmesine rağmen, birey sayısındaki farklılığın buna sebep olduğu düşünülmektedir. Ayrıca Anadolu’da yapılan spina bifida (SB) çalışmalarında, bu insidansın Kuzey ve Doğu bölgelerinde, Batı bölgesine göre daha yüksek görülmesi, folik asit alımı ile SBO arasındaki ilişkiyi destekleyecek niteliktedir.
... b, Sacralisation of L5. Sagittal CT image demonstrates sacralised L5 vertebral body The wide range in frequency in the different studies [9,11,[16][17][18][19][20][21][22][23][24][25][26][27] (Table 4) can be explained by a variance in study objectives, design, focus and technique. The populations investigated were heterogeneous with regard to age, ethnicity and gender, as were the materials used (e.g. ...
Article
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Introduction: The success of sacral nerve stimulation, a common treatment for pelvic floor disorders, depends on correct placement of the electrodes through the sacral foramina. When the bony anatomy and topography of the sacrum and sacral spinal nerves are intact, this is easily achieved; where sacral anomalies exist, it can be challenging. A better understanding of common sacral malformations can improve the success of sacral nerve stimulation (SNS) electrode placement. Material and methods: We reviewed 998 consecutive MRI scans performed to investigate low back pain in patients who had undergone CT and/or X-ray. Results: Congenital sacral malformations were found in 24.1 %, the most common being sacral meningeal cysts (16 %) and spina bifida occulta (9.9 %). Others were lumbosacral transitional vertebrae (2.5 %), anterior occult meningocele (0.5 %), partial sacral agenesis (0.2 %) and vertebral dysplasia of S1 (0.2 %). Conclusion: This radiologic review uncovered a high incidence of sacral malformations, and most were asymptomatic. All surgeons who perform SNS should have a basic understanding of sacral malformations, their incidence and effect on foraminal anatomy. Imaging will aid procedural planning.
Article
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The median artery has been considered as an embryonic structure, which normally regresses around the 8th week of gestation. However, various prevalences have been reported in adults since the 18th century. Furthermore, in a study by Henneberg and George (1995; Am J Phys Anthropol 96, 329-334), has suggested that increasing prevalence of the median artery during the 20th century was a 'possible secular trend'. The present study, conducted nearly a quarter of a century later, is a continuation of that study. A total of 26 median arteries were found in 78 upper limbs obtained from Australians aged 51 to 101 years, who died in the period 2015-2016, a prevalence rate of 33.3%. Analysis of the literature showed that the presence of the median artery has been significantly increasing (p = .001) over time, from approximately 10% in people born in the mid-1880s to approximately 30% by the end of the 20th century. The significance of the prevalence increased to a p value <.0001, when the results of the present study and other studies conducted by our research team were combined. After removal of the studies that were possibly biased, because of their specific focus on the evolutionary aspects of the median artery, the significance remained at p = .018. The present study provides an example of microevolutionary changes in the internal anatomy of the human body. Second-order polynomial regression of the median artery's prevalence on dates of birth shows that it is now present in 35% of people and predicts that people born 80 years from now will all carry a median artery if the trend continues. When the median artery prevalence reaches 50% or more, it should not be considered as a variant, but as a 'normal' human structure.
Article
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Stable carbon and nitrogen isotope results are presented for a sample of human and faunal bones and food remains excavated from Pompeii. The well-preserved organic remains provide a valuable resource to examine ancient lifeways associated with a Roman city during a distinct period of time associated with the eruption of Vesuvius in AD 79. Isotopic results indicate human diets that are consistent with the archaeological and documentary evidence for diverse dietary intake for all residents of Pompeii consisting of a range of cereals, fruits, vegetables, seafood, and meat from domestic and wild animals. Males had similar animal protein intakes to those of females, but they ingested significantly greater amounts of seafood than females. The great range of dietary variability among and between males and females indicated by the isotopic data suggests the existence of past dietary distinctions based on social role and/or social class. In comparison to other isotopic studies in the region, human diets at Pompeii are similar to those of Danish farmers and coastal Greek colonies in southern Italy (Metaponto) but included greater amounts of marine protein. Carbon isotope values for domestic animals indicate a C 3-based terrestrial diet, while nitrogen isotope values distinguish herbivores from omnivores and carnivores.
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Two skeletal anomalies are examined from two protoArikara skeletal series, those from the Sully (39SL4) and Larson (39WW2) sites of South Dakota. There are differences between Larson and Sully in the incidence of both anomalies. Larson has the greater incidence of spina bifida occulta, but cases appear in older individuals. Larson also has a higher frequency of separate neural arches. Separate neural arches appear to be associated with osteoarthritis development in the Larson series. This association is not apparent in Sully individuals.
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Article
Identification of Pathological Conditions in Human Skeletal Remains provides an integrated and comprehensive treatment of pathological conditions that affect the human skeleton. There is much that ancient skeletal remains can reveal to the modern orthopaedist, pathologist, forensic anthropologist, and radiologist about the skeletal manifestations of diseases that are rarely encountered in modern medical practice. Beautifully illustrated with over 1,100 photographs and drawings, this book provides essential text and materials on bone pathology, which will improve the diagnostic ability of those interested in human dry bone pathology. It also provides time depth to our understanding of the effect of disease on past human populations.
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This reference work is an attempt to provide an integrated and reasonably comprehensive treatnient of pathological conditions that affect the human skeleton. The primary objective is to assist those who conduct research on archeological skeletal remains in interpreting abnormal conditions that they might encounter in the course of their research. However, there is much that ancient skeletal remains can reveal to the modern medical historian, orthopaedist, pathologist, and radiologist about skeletal diseases that are rarely encountered in modern clinical practice. All of the major categories of disease that affect bone are reviewed from the viewpoint of the pathologist. This review is followed by a discussion of the literature on the paleopathology of each condition and the presentation of paleopathological cases thought to represent each of the morbid categories affecting bone. This work is based on extensive individual and collaborative research by both authors on the known parameters of modern skeletal diseases and their expression in antiquity. The monograph provides essential text and illustrative materials on bone pathology, which will improve the diagnostic ability of those interested in human dry bone pathology.
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Though the pathological changes in bones of the early Japanese people have attracted attention of physical anthropologists for more than half a century, the descriptions of only a few pathological anomalies have been published in various independent reports.The present study deals with various kinds of pathological changes in vertebral columns. As shown in Table 1, 188 vertebral columns in total from Jomon to Edo periods were observed. Since the skeletal remains from Yayoi to Muromachi periods are in very poor condition, and as many skeletal remains of Edo period were found in group burials, skulls and post-cranial skeletons could not be identified with certainty.Spondylosis deformans which forms osteophytes in vertebrae was classified according to various types and grade as shown in Figure 1, The incidence of osteophytes in the male of Jomon and Edo periods are given in Table 2.Regarding the degree of osteophytes, significant statistical differnces were observed between Jomon and Edo people. The former have higher frequencies in grades II, III and N, than the latter. This seems to reflect the difference of the condition of subsistence especially of the intensity of physical working. The highest frequency of osteophytes was seen in the lower thoratic and the lumbal spines, especialy in L-2 and L-3. The degree of osteophytes (grade) changes from grade I to IQ and N with the advance of age.Lumbo-sacral transitional vertebrae, spina bifida occulta, and Schmorl's node were also observed. The incidences of each type of these malformations in both sexes are given in Tables 3, 4 and 5.Lumbo-sacral transitional vertebrae was classified into four types set forth by JINNAKA according to the process of articular formation as shown in Figure 2. Spina bifida occulta in the sacrum was classified into two types, complete type and imcomplete type. The former was not recog nized at all in every period. The incidences of the later range from 10% to 13%.Schmorl's node was found frequently on the lower thoratic and the lumbal vertebral bodies as it was the case with spondylosis deformans.Other interesting pathological changes in vertebrae diagnosed as spondylitis tuberculosa, spondylarthritis ankylopoetica, vertebral body fracture, congenital intravertebral ankylosis, congenital anomalies, etc., were described. As for the origin of tuberculosis in Japan, this infectious disease is supposed to have been imported from the Asian continent in Yayoi or Kof un period by immigrants who introduced continental culture to this country.
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On the basis of the skeletons in 103 Japanese, 100 American Whites and 97 American Blacks, the usefulness of the base-wing index for sexing the sacrum was ascertained by means of the size and shape distances, generalized distances and discriminant functions of the widths of base and lateral part (wing) of the sacrum, in addition to the distribution of the index, between the male and female series. In relation to sex differences of the sacrum, the shape component was more important than the size for these measurements, at least. With the discriminant functions of these dimensions, the probability of sexing the sacrum was 75.32% in Japanese, 80.88% in American Whites and 82.70% in American Blacks. In the distribution of the base-wing index, the overlap samples between the mare and _??_ were 26.2%, 22.0% and 16.5% in each population, respectively.
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The effect of administration of folinic acid, vitamin B6 + vitamin B12, and their combination on valproic acid (VPA)-induced teratogenesis was studied in NMRI mice. VPA (500 mg/kg, sc) was injected on Day 8 of gestation and the vitamins (two dose levels) were injected ip 1 hr before, immediately before, and 1 hr after VPA administration. Folinic acid significantly reduced VPA-induced resorptions (21–24%), and palate, rib, and sternebral malformations. Exencephaly and spina bifida occulta were also reduced (14 and 40%, respectively), but the difference was not statistically significant. On the other hand, vitamin B6 + vitamin B12 significantly reduced VPA-induced exencephaly (23%), spina bifida occulta (80%), palate and rib malformations, kidney abnormalities, and fetal weight retardation. A combination of the three vitamins was effective in reducing VPA-in duced exencephaly (23–30%), spina bifida occulta (60%), and palate and rib malformations. The protection against VPA-induced malformations was not complete and was not always dose related, and the reduction in exencephaly rate was only significant in the absence of a reduction in resorption rate. Full-length cleft palate, sternebral malformations, and retarded sternebral and caudal ossification were, however, increased by the high dose of combined vitamin administration. The present study supports the view that VPA-induced teratogenesis may be mediated via an interaction with folate metabolism. Although folinic acid and vitamin B6 + vitamin B12 can effectively reduce VPA malformations, the protection was not complete, which may suggest the involvement of other factors. Furthermore, the dose levels should be carefully chosen since high doses of the combined vitamins can actually increase the incidence of certain defects.