Article

Scheuermann’s disease in a juvenile male from the late Roman necropolis of Torrenueva (3rd–4th century CE, Granada, Spain)

Authors:
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

This study details a severe case of Scheuermann’s disease (SD) in a well-preserved skeleton of a juvenile male (designated TOR302), dated to 3rd–4th century CE, from the late Roman necropolis of Torrenueva (Granada, Spain). Individual TOR302 shows an evident kyphotic curve in the thoraco-lumbar spine, which is characterised by: (i) vertebral bodies of thoracic vertebra T2, thoracic segment T4–T9, and thoraco-lumbar segment T12–L2 wedged at >5°; (ii) slight anterior extensions of the epiphyseal ring; (iii) Schmorl’s nodes on the superior and/or inferior plates; and (iv) a Cobb angle of 75°, derived from thoracic segments T4–T9. In addition, TOR302 shows other skeletal malformations as the secondary results of abnormal growth, due to altered biomechanical forces imposed by the spinal deformity, including: (i) lateral distortion of the spine that causes a slight secondary scoliotic curve; (ii) pelvic obliquity; and (iii) discrepancy in the length of the limbs. We argue that the secondary skeletal abnormalities allowed the individual to adapt to his spinal deformity meaning he was able to walk without the aid of a stick. Despite SD being a common modern clinical finding, few cases have been reported in ancient skeletal remains. This case therefore represents an important contribution to the palaeopathological literature.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the authors.

... However, in the present study, we used a less known structured light scanner (HP 3D Structured Light Scanner Pro S2), which uses projected light patterns and a camera system to capture the three-dimensional shape of an object. This particular scanner (previously known as David SLS) has already been used in several studies for scanning both human and animal bones [69][70][71][72], as well as for other purposes [73][74][75]. Recently, the accuracy and reproducibility of the scanner were tested on mannequin faces, as well as those of live subjects [76]. ...
Article
Full-text available
The age-at-death estimation thresholds have recently been shifted towards a more objective assessment of the aging process. Such a non-subjective approach offers quantitative methods of age estimation; for instance, the method relating to the surfaces of pubic symphyses of males published by Stoyanova et al. (J Forensic Sci 62:1434–1444, 2017). A validation study was conducted to test the method performance in European samples. The sample consisted of 96 meshes of pubic symphyses of male individuals (known sex and age) that came from four different samples (two Portuguese collections, one Swiss, and one Crete). Stoyanova’s method based on five regression models (three univariate and two multivariate models) performed worse in our sample, but only when the whole sample (without age limitation) was included. A sample limited to individuals under 40 years of age achieved better results in our study. The best results were reached through the thin plate spline algorithm (TPS/BE) with a root mean square error of 5.93 years and inaccuracy of 4.47 years. Generally, the multivariate regression models did not contribute to better age estimation. In our sample in all age categories, age was systematically underestimated. The quantitative method tested in this study works best for individuals under 40 years of age and provides a suitable basis for further research.
Article
Analyses of human skeletal shape and geometry are used to investigate questions related to habitual activities and physical lifeways, as well as biological distance and relatedness. Recently, these methods have been applied to research concerning human evolutionary predisposition for disease, as well as functional experiences of pathological conditions. The use of these methods to address palaeopathological questions are relatively new, but related questions and approaches are gaining momentum. This manuscript provides an in‐depth review of the current state of this palaeopathological research by undertaking a meta‐analysis of anthropological literature. From the results of the meta‐analysis, we observe an increase in the use of quantitative shape analyses in palaeopathology, and identify four key themes in this literature: (1) description and diagnosis, (2) shapes that increase pathological risk, (3) shape change that arises from pathology, and (4) shape used for social insight. As this area of study develops, we recommend adaptations to measurement and data collection; comparative examinations of remains at the individual, population, and species levels; and, when possible, representation of all human variation through the inclusion of pathological individuals in geometric analyses. Palaeopathologists are ideally suited to investigate the relationship between bone shape and health, which may prove essential to the continued understanding of disease in both past and contemporary contexts.
Article
Variations in the number, size and shape of the foramina transversaria of cervical vertebrae can affect the anatomical course of vital blood vessels and nerves, with the risk for pathological conditions, like vertebrobasilar insufficiency. This can result in compression of the vertebral artery during neck movements, which is characterised by headache, migraine, difficulties in swallowing, problems with speech and sight, balance disturbances and hearing disorders, among others. The aim of this study was to analyse the prevalence of the diverse anatomical variants of the foramen transversarium in 446 cervical vertebrae from the skeletal remains of 83 victims who died on the ancient beach of Herculaneum (Italy) during the eruption of Vesuvius Volcano in 79 CE. There were complete and incomplete double foramina transversaria in 20.6% of the vertebrae, and absence of foramen transversarium in an atlas (0.2%), a very rare condition in the literature. As the foramen transversarium is a key determinant for correct development of the vertebral artery, evaluations of variations in its number, size and shape provide useful information on the prevalence of these variations in the life and health conditions in the ancient population of Herculaneum.
Article
Cervical ribs constitute the most important variants among ribs, particularly because of their proximity to the brachial plexus nerve network and subclavian artery. Thus, cervical ribs may exert excessive pressure upon these structures, producing a variety of symptoms that may be considered as a neuro-vascular complex. Cervical ribs are not uncommon in the catalogue of anatomic abnormalities in modern medicine, but few cases have been reported from historic skeletal material. We conducted a review with the existent articles published in palaeopathological literature, the historical background with the most important milestones regarding the studies on cervical ribs, the embryological processes in their development, and their prevalence and principal clinical features. Finally, we described a case of a cervical rib that was observed in the skeletal remains of a young individual from the late medieval cemetery of Corfinio (12th-13th century CE, Italy).
Article
Full-text available
The 3D imaging technologies have become of paramount importance for example in disciplines such as forensic anthropology and bioarchaeology, where they are being used more and more frequently. There are several new possibilities that they offer; for instance, the easier and faster sharing of data among institutions, the possibility of permanent documentation, or new opportunities of data analysis. An important requirement, however, is whether the data obtained from different scanning devices are comparable and whether the possible varying outputs could affect further analyses, such as the estimation of the biological profile. Therefore, we aimed to investigate two important questions: (1) whether 3D models acquired by two different scanning technologies (structured light and laser) are comparable and (2) whether the scanning equipment has an effect on the anthropological analyses, such as age-at-death estimation and sex assessment. 3D models of ossa coxa (n = 29) were acquired by laser (NextEngine) and structured light (HP 3D Structured Light Scanner PRO 2) scanners. The resulting 3D models from both scanners were subjected to age-at-death analyses (via the quantitative method of Stoyanova et al., 2017) and sex analyses (via Diagnose Sexuelle Probabiliste 2 of Brůžek et al., 2017). Furthermore, high quality scans of a small sample (n = 5) of pubic symphyseal surfaces with the RedLux Profiler device were acquired as reference surfaces to which the outputs from both scanners were compared. Small deviations between surfaces were more evident in more rugged surfaces (in areas of depression and protrusion). Even though small differences from the reference surfaces were found, they did not have a significant effect on the age and sex estimates. It never resulted in the opposite sex assignment, and no significant differences were observed between age estimates (with the exception of those with the TPS/BE model).
Article
Full-text available
Pituitary gigantism is a rare endocrine disorder caused by hypersecretion of growth hormone during growing period. Individuals with this disorder have an enormous growth in height and associated degenerative changes. The continued hypersecretion of growth hormone during adulthood leads to acromegaly, a condition related to the disproportionate bone growth of the skull, hands and feet. The skeletal remains studied belong to a young adult male from the Jewish necropolis of “Ronda Sur” in Lucena (Ćordoba, Spain, VIII–XII centuries CE). The individual shows a very large and thick neurocranium, pronounced supraorbital ridges, an extremely prominent occipital protuberance, and an extremely large and massive mandible. Additional pathologies include enlargement of the vertebral bodies with degenerative changes, thickened ribs, and a slight increased length of the diaphysis with an increased cortical bone thickness of lower limbs. Comparative metric analysis of the mandible with other individuals from the same population and a contemporary Mediterranean population shows a trend toward acromegalic morphology. This case is an important contribution in paleopathological literature because it is a rare condition that has not been widely documented in ancient skeletal remains.
Article
Full-text available
The mode of Scheuermann's disease inheritance and its phenotypic traits in probands and their relatives were studied in 90 pedigrees (90 probands and 385 relatives). The disorder was identified as a genetically related pathology inherited by autosomal dominant type, controlled by a mutant major gene, as a kyphotic deformity without signs of vertebral bodies' anomaly and torsion. Morphological and biochemical studies showed disturbance in the structure of vertebral growth plate anterior aspects at the level of deformity, defects in proliferation and differentiation of chondrocytes, and change in proteoglycan spectrum in cells and matrix. Twelve candidate genes were studied in chondrocytes isolated from vertebral growth plates of patients with Scheuermann's disease. The study results included disorder in the IHH gene expression and preservation of the expression of PAX1, two aggrecan isoforms, link protein, types I and II collagen, lumican, versican, growth hormone and growth factor receptor genes, and proliferation gene. Preservation of the SOX9 gene (transcription gene) probably indicates posttranscriptional genetic disorders. The study is under way.
Article
Full-text available
The impact of sagittal plane alignment on the treatment of spinal disorders is of critical importance. A failure to recognise malalignment in this plane can have significant consequences for the patient not only in terms of pain and deformity, but also social interaction due to deficient forward gaze. A good understanding of the principles of sagittal balance is vital to achieve optimum outcomes when treating spinal disorders. Even when addressing problems in the coronal plane, an awareness of sagittal balance is necessary to avoid future complications. The normal spine has lordotic curves in the cephalad and caudal regions with a kyphotic curve in between. Overall, there is a positive correlation between thoracic kyphosis and lumbar lordosis. There are variations on the degree of normal curvature but nevertheless this shape allows equal distribution of forces across the spinal column. It is the disruption of this equilibrium by pathological processes or, as in most cases, ageing that results in deformity. This leads to adaptive changes in the pelvis and lower limbs. The effects of limb alignment on spinal posture are well documented. We now also know that changes in pelvic posture also affect spinal alignment. Sagittal malalignment presents as an exaggeration or deficiency of normal lordosis or kyphosis. Most cases seen in clinical practise are due to kyphotic deformity secondary to inflammatory, degenerative or post-traumatic disorders. They may also be secondary to infection or tumours. There is usually pain and functional disability along with concerns about self-image and social interaction due to inability to maintain a horizontal gaze. The resultant pelvic and lower limb posture is an attempt to restore normal alignment. Addressing this complex problem requires detailed expertise and awareness of the potential pitfalls surrounding its treatment.
Article
Full-text available
Brucellosis is a worldwide disease. Although it has been eradicated in some countries, it continues to be an important disease in many farming areas. Previous works have described the evolution and diffusion of brucellosis in antiquity through direct analysis of ancient human remains collected by the University Museum of Chieti, Italy, and by using paleopathological and historical data. The earliest published case was reported in a skeletal individual dated to the Middle Bronze Age. However, our research group has diagnosed vertebral brucellosis in the partial skeleton of the late Pliocene Australopithecus africanus, demonstrating that this infectious disease occasionally affected our direct ancestors 2·3-2·5 million years ago. The frequency of brucellosis increased during the Roman period, when the disease would almost certainly have been endemic in Roman society, and during the Middle Ages. Most paleopathological cases involve adult male skeletal individuals, and lumbar vertebrae and sacroiliac joints are most commonly involved.
Article
Full-text available
Tuberculosis has plagued humans and animals for thousands of years. Though apparently in decline with the advent of effective chemotherapy and improved living conditions, sanitation, and diet during the first half of the 20th century, TB has reawakened in both developed and developing countries, particularly among susceptible populations with immunodeficiency disorders. These authors offer a detailed study of the history of this persistent and important infectious disease, covering its etiology, epidemiology, and pathogenesis. Beginning with a discussion of the epidemiology, clinical signs and symptoms of tuberculosis, and skeletal changes associated with it, Roberts and Buikstra examine evidence for the disease through time in both human and nonhuman populations. They devote particular attention to the paleopathological evidence of tuberculosis throughout human history found in both Old and New World archaeological sites. With a review of the hard evidence of tuberculosis from the archaeological record (skeletons showing evidence of the disease), they focus on how and why the disease developed in antiquity, its evolutionary routes, and how past populations treated it. The authors augment clinical data with evidence from a variety of sources including art and documentary materials. A concluding chapter addresses the current reemergent status of the disease and its future prospects. The authors reveal that tuberculosis has repeatedly increased over time as societies have become more complex socially, economically, and politically. Their detailed presentation of the clinical data on tuberculosis and its many causative factors brings together information from a wealth of sources worldwide and mounts an argument rich in paleoepidemiological and historical data that challenges accepted dogma about the conquest of TB by modern technology. Their account will be of interest to anthropologists, archaeologists, biologists, and sociologists as well as clinicians and medical historians.
Article
Full-text available
Determination of the sex of human bone remains represents a crucial stage in any palaeoanthropological study. The palaeobiological or palaeoethnological interpretations depend on its reliability. It is acknowledged that the adult hip-bone (os coxae) is by far the best non-population-specific indicator for reliable sex determination of adults. However, we clarify here a certain number of limitations which lower the reliability and ease of application of the usual methods. We propose a new tool—Probabilistic Sex Diagnosis (DSP: Diagnose Sexuelle Probabiliste)—based on a worldwide hip-bone metrical database (2040 adult specimens of known sex from 12 different reference populations). Sex is determined by comparing the specimen’s measurements to those from the database and by computing the individual probability of being female or male, from any combination of at least four variables among ten. This method is very easy to learn and apply; it provides sex diagnosis for any anatomically modern human, whatever population the specimen belongs to. Numerous combinations allow sex diagnosis of either well—preserved hip-bones or damaged ones. DSP is thus useful for both archaeological and forensic purposes. Its accuracy is close to 100%. The DSP computing program is available at the following web link: http://www.pacea.u-bordeaux1.fr/publication/dspv1.html
Article
Full-text available
A morphometric study of the linear and angular parameters of the spinal vertebra was conducted by computerized tomographic scans and comparison with previous studies in literature. Detailed knowledge of the spinal vertebral morphometry is important for proper instrumentation. The morphologic measurements vary among races. Morphometric studies have been conducted in white populations. This study aims to suggest dimensions for anterior and posterior spinal implants and to improve the instrumentation techniques. The vertebral pedicles, bodies and intervertebral disc spaces of the subaxial cervical, thoracic and lumbar spine were studied in 48 healthy individuals by computerized tomographic scan methods. The following parameters were studied: pedicle length, pedicle width, transverse pedicle angle (TPA), sagittal pedicle angle, anterior corpus height, posterior corpus height, anterior disc height, middle disc height and posterior disc height. Our results were slightly different compared to previous studies. Individual differences were found in the same subgroups. The transverse pedicle diameter was largest at L5 (14.95 mm) and smallest at C3 (5.1 mm). The pedicle was longest at L5 (19.9 mm) and shortest at T10 (15.7).The TPA was largest at C3 (47.6 degrees ) and smallest at T6 (11.3 degrees ). The vertebral body was largest at L5 (34.9 mm) and smallest at C3 and C5 (15.6 mm). The vertebral body width was largest at L5 (46.6 mm) and smallest at C4 (22 mm). The intervertebral disc space height was largest at L2-3 (10 mm) and smallest at T1-2 (2.85 mm). There were no significant differences between the left and right sides. In our morphometric study of the spinal vertebrae, we found differences compared to a number of previous morphometric studies performed mainly on a white population. Also, we documented the individual morphometric differences of the same parameters in the same subgroups. These results emphasize the importance of preoperative computed tomography and conventional radiography of each patient in planning a surgical procedure and selecting the appropriate size of the instruments, thus avoiding possible postoperative complication related to implants.
Article
Full-text available
The effect of mild leg length inequality (lower extremity length difference less than 3 cm) on posture and gait has been the source of much controversy. Many opinions have been expressed both for and against the need for intervention to reduce the magnitude of the discrepancy. This paper emphasizes the need for accurate and reliable assessment of leg length differences using a clinically functional radiographic technique, and reviews the biomechanical implications of leg length inequality as related to the development of stress fractures, low back pain and osteoarthritis.
Book
Developmental Juvenile Osteology was created as a core reference text to document the development of the entire human skeleton from early embryonic life to adulthood. In the period since its first publication there has been a resurgence of interest in the developing skeleton, and the second edition of Developmental Juvenile Osteology incorporates much of the key literature that has been published in the intervening time. The main core of the text persists by describing each individual component of the human skeleton from its embryological origin through to its final adult form. This systematic approach has been shown to assist the processes of both identification and age estimation and acts as a core source for the basic understanding of normal human skeletal development. In addition to this core, new sections have been added where there have been significant advances in the field. Identifies every component of the juvenile skeleton, by providing a detailed analysis of development and ageing and a detailed description of each bone in four ways: adult bone, early development, ossification and practical notes. New chapters and updated sections covering the dentition, age estimation in the living and bone histology. An updated bibliography documenting the research literature that has contributed to the field over the past 15 years since the publication of the first edition. Heavily illustrated, including new additions.
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.
Article
Little is known about fusion times of the primary and secondary centers of ossification in the sacrum, particularly from dry bone observations. In this study, the timing of union of these centers was studied in a sample of modern Portuguese skeletons (90 females and 101 males) between the ages of 0 and 30 years, taken from the Lisbon documented skeletal collection. A three-stage scheme was used to assess fusion status between ossification centers as unfused, partially fused and completely fused. Posterior probability tables of age, given a certain stage of fusion, were calculated for most anatomical locations studied using both reference and uniform priors. Partial union of primary centers of ossification was observed from 1 to 8 years of age and partial union of secondary centers of ossification was observed from 15 to 21 years of age. The first primary centers of ossification to complete fusion are the neural arch with the centrum of the fifth sacral vertebrae and the last are the costal element with the centrum of the first sacral vertebra. The annular and sacroiliac epiphyses are the first, among the secondary centers of ossification observed, to complete fusion, after which the lateral margin fuses. This study offers information on timing of fusion of diverse locations in the developing sacrum useful for age estimation of complete or fragmented immature human skeletal remains and fills an important gap in the literature, by adding to previously published times of fusion of primary and secondary ossification centers in this sample. Am J Phys Anthropol, 2013. © 2013 Wiley Periodicals, Inc.
Article
The skeletal remains of an adult female have been exhumed in an 11th century tomb in the mediaeval Jewish cemetery of Ronda Sur, in the city of Lucena (Córdoba, Spain). Examination of the skull and mandible revealed evidences of bilateral condylar fracture and dislocation. Lesions were observed macroscopically and radiology was used as a complementary method of scrutiny, especially in cases of unclear observation. Irregular morphology of the condyles and coronoid processes, shallow glenoid fossa, altered and abnormal joint surfaces anterior to the glenoid fossa, and reduced height of both ascending rami were observed. Ante-mortem tooth loss, slight wear of occlusal surface and asymmetrical occlusal deposit of dental calculus were found. Radiologically, degenerative changes in the condyles and reparative bone in both coronoid processes have been identified. Dislocation of the condyles and lack of adequate treatment probably led to disruption of masticatory patterns and related structures, such as muscle attachments, articular disc and ligaments. Bilateral remodelled fracture and the altered appearance of the joint structures could probably mean that the individual survived the injury by several years. This type of fracture could be the consequence of direct blow to the mental or submental region that was transmitted in a direction that raised the mandible, causing the condylar head to collide directly with the mandibular fossa. Very few mandibular fractures in ancient skulls have been described in Spain, and this case is the first example found in a Spanish archaeological skeletal assemblage. Copyright © 2011 John Wiley & Sons, Ltd.
Article
Reports of congenital scoliosis (CS) are rare in the literature of paleopathology. This study details severe CS in the complete, well preserved skeleton of an adult male, dated to AD 550–800, from the Sudanese site of Kulubnarti. This skeleton, designated as S-16, is the most complete archaeologically derived example of CS to be documented. Copyright © 2009 John Wiley & Sons, Ltd.
Article
Holger Werfel Scheuermann (1877-1960) a Danish surgeon serving in Copenhagen published this report in 1921, during the period before the osteochondroses-then know as osteochondritis-were considered similar pathological entities. It appeared near the end of an era when orthopedic disease or surgical eponyms were a mark of distinction. "Scheuermann's disease" entered the list immediately. E.M.B. (C) Lippincott-Raven Publishers.
Article
This paper details the differential diagnosis of an adult female skeleton displaying features consistent with a cartilaginous dysplasia and Osgood–Schlatter's disease. This burial was excavated in 1940 from a Mississippian platform mound at the DeArmond site (40RE12) in Roane County, Tennessee as part of the Works Progress Administration (WPA) and Tennessee Valley Authority (TVA) archaeological investigations. The right humerus and left femur of this individual display traits consistent with achondroplasia, such as shortened length and normal width. However, the rest of the long bones display typical morphology. The affected humerus and femur are 82 mm and 58 mm shorter than their counterparts, respectively. This makes for obvious asymmetry. A review of the various cartilaginous dysplasias was undertaken to identify those conditions concordant with the differential manifestation of the long bone asymmetry. Morphological and radiographic analyses were used to rule out possible diagnoses. The most likely candidate is enchondromatosis out of the presented conditions, as it most commonly affects the long bones, does not affect every bone in the skeleton, and is asymmetrical in its manifestation. In addition to the cartilaginous dysplasia, both anterior proximal tibial metaphyses of this individual display defects that are roughly triangular with pitted, irregular floors. Osgood–Schlatter's disease is caused by repeated trauma to the tibial tuberosity during childhood. This individual would have walked with an obvious limp, and perhaps the added biomechanical stress on both quadriceps muscles as a result caused the injuries and resultant defects to its attachment points. Evidence of these conditions in an adult indicates that the Mississippian people in this community offered some sort of social support to differently-abled individuals. Copyright © 2009 John Wiley & Sons, Ltd.
Article
During excavations in Akarçay Höyük, located in Birecik (Şanlıurfa, Turkey), a human and a horse skeleton were found together as a co-burial. This burial was in an Islamic cemetery dated to 13th–14th century AD. The human skeleton was that of a young adult female with a distinct thoracic kyphosis. Three adjacent thoracic vertebral bodies, T4, T5 and T6, were wedge shaped and this wedging was also apparent in radiographs. There were Schmorl's nodes and anterior extensions on the same vertebral bodies. All these vertebral changes are typical signs of Scheuermann's disease (SD). Since she was buried with a horse, it is likely that she was a horse rider. Although she was young, the skeletal changes associated with horse riding like elongated acetabula and enthesopathies on the femora were evident. There was a compression fracture on T12, and irregularities on the upper and lower vertebral body rims due to traumatic anterior disc herniation. It is postulated that a trauma due to horse riding is responsible for the occurrence of SD in this case. Copyright © 2009 John Wiley & Sons, Ltd.
Article
The objectives of palaeopathological research include: (i) diagnosis of specific diseases in archaeological human remains; (ii) analysis of the impact of various diseases in human populations through time and space; and (iii) clarification of evolutionary interactions between humans and disease. Basic to all these objectives is the need for accuracy in diagnosing diseases in archaeological human remains. Tests of diagnostic accuracy made during workshops in dry bone diagnosis held during the annual meetings of the Paleopathology Association (PPA) in 1989, 1990, 1991 and 1992 suggest important limitations that need to be considered in the development of methods in palaeopathology. Although the conditions do not approximate those found in most field or laboratory situations, these tests indicate an overall accuracy of 28.6 per cent for specific disease recognition and 42.9 per cent accuracy for correct recognition of the more general categories of disease. The factors in diagnostic accuracy are complex and include the knowledge and experience of the observer. Another factor is the often substantial morphological overlap between different diseases. In the classificatory system used for the workshops there are seven general categories of disease, each of which has recognizable, although often non-specific, hallmarks in dry bone specimens. A differential diagnosis with these seven general possibilities in mind rather than hundreds of specific diseases can be a powerful tool for the palaeopathologist in providing data that are more comparable between observers. This improvement in classificatory agreement has important methodological implications in the development of a data protocol in palaeopathological research. The identification of general disease category is recommended as part of descriptive and diagnostic reports on palaeopathological specimens.
Article
The frequency with which changes related to vitamin D deficiency are recorded in juvenile bone from archaeological contexts makes it clear that conditions conducive to such deficiency were fairly widespread at a number of points in the past. Although changes will take longer to be manifest in the adult skeleton than in juveniles, and may not be as obvious, the scarcity of reported cases suggests that it is likely that cases of osteomalacia are being overlooked in archaeological human bone. Vitamin D is probably better described as a hormone, rather than a vitamin, and the production of vitamin D within the body following exposure to sunlight allows adequate mineralisation of bone to take place. Lack of exposure to sunlight, which can be caused by a range of factors, is probably one of the main causes of vitamin D deficiency. The result of such a deficiency is a general weakening of the skeleton. The range of skeletal changes recorded across different bones of the skeleton in two documented historical pathology collections (the Galler collection, Basel, and the collection of the Federal Museum for Pathological Anatomy, Vienna), are discussed for scapulae, vertebrae, ribs, sterna, pelves and femora. The likelihood of each feature being preserved in archaeological skeletal material is considered. Although the changes associated with osteomalacia may lead to fragmentation of the skeleton, the presence of characteristic changes on bones from across the skeleton should make the condition identifiable using macroscopic examination, even where the skeleton is not well preserved. The identification of cases of osteomalacia in archaeological skeletal material is potentially significant because of the socio-cultural information that can be implied from diagnosis of the condition. Copyright © 2005 John Wiley & Sons, Ltd.
Article
Ten vertebral elements from the AL-288 partial hominid skeleton and 11 elements from the AL-333 collection are described. The AL-288 column presents a marked kyphosis at the level of thoracic vertebrae 6 through 10, with pronounced new bone formation on the ventral surfaces of these vertebrae. These features, associated with narrowed disc space and minor osteophytosis, resemble Scheuermann disease in the human. Even though this diagnosis is consistent with a basically human, bipedal locomotor repertoire, the presence of Scheuermann disease suggests that lifting, climbing, or acrobatic activities may have been important in early hominids.
Article
Directional bilateral asymmetries in human gross skeletal morphology are largely attributable to differential mechanical loading from handedness during endochondral bone growth. While much has been done in the way of identifying directional asymmetries of the upper limb in relation to handedness, comparatively little research has focused on asymmetry in the lower body. The present paper analyses asymmetry in the human sacrum in a sample of 238 modern individuals. Measurements of right and left sides of the lateral and posterior breadths of the alae and the maximum height of the auricular surface were used. Asymmetry was calculated as: [(left side − right side) ÷ right side] * 100. Directional asymmetry was identified using a one-sample t-test against a hypothesized mean of zero. Significant directional asymmetry (P < 0.05) was found in all three dimensions. The pattern of asymmetry is consistent with models describing the influence of right-handedness on the lower body, which predicts that left side dimensions will be larger. Copyright © 2002 John Wiley & Sons, Ltd.
Article
The pelvis may be seen as a single vertebra, between the spine and the femurs. The anatomy of this pelvic vertebra has changed with the evolution of species, notably with the transition to bipedalism, with the consequent appearance of lumbar lordosis. The lumbosacral angle, almost non-existent in other mammals, is at its greatest in humans. Pelvic and spinal radiological parameters reflect the sagittal balance of the spine in bipedal humanity. Applications in the management of spinal imbalance are numerous. Arthrogenic or degenerative kyphosis is the stereotypic example of spinal aging. Postoperative flat back following spine surgery is hard to prevent. Scoliosis surgery in adults should now take greater account of the patient's individual sagittal balance, by analyzing the pelvic and spinal parameters. The extent of arthrodeses performed during adolescence to manage idiopathic scoliosis may also induce problems of balance in adulthood if these elements are not taken into account.
Article
Four human skeletons probably could be attributed to people killed during the Battles of Zürich in 1799. Cranial and postcranial gunshot wounds are consistent with those made by black powder weapons using lead balls as ammunition. Additional finds include a probable case of Scheuermann's Disease and a pipe smoker's facet.
Article
Osteochondrosis is a term used to describe a group of disorders that affect the growing skeleton. These disorders result from abnormal growth, injury, or overuse of the developing growth plate and surrounding ossification centers. The exact etiology of these disorders is unknown, but genetic causes, repetitive trauma, vascular abnormalities, mechanical factors, and hormonal imbalances may all play a role. Legg-Calvé-Perthes disease is a hip disorder that causes hip pain, an atraumatic limp, and knee pain. Osgood-Schlatter and Sinding-Larsen-Johannson diseases are common causes of anterior knee pain that is aggravated by jumping activities and kneeling. Sever disease causes heel pain that is exacerbated by activity and wearing cleats. It often mimics Achilles tendinitis and is treated with activity and shoe modifications, heel cups, and calf stretches. Freiberg disease and Köhler bone disease often cause foot pain and are disorders of the metatarsal head and navicular bone, respectively. Radiographs show sclerosis, flattening, and fragmentation of bone in both diseases. Elbow pain can be caused by medial epicondyle apophysitis or Panner disease. Medial epicondyle apophysitis is exacerbated by frequent throwing and is treated with throwing cessation and acetaminophen or nonsteroidal anti-inflammatory drugs. Panner disease is the most common cause of lateral-sided elbow pain in children younger than 10 years. It may or may not be associated with frequent throwing, and it resolves spontaneously. Scheuermann disease causes back pain and a humpback deformity from vertebral bone anterior wedging.
Article
This study further tests the general assumption that skeletal development is more sensitive to socioeconomic factors than dental development in a sample of modern immature Portuguese skeletons (N = 41) of known sex, age, and socioeconomic background. Skeletal development was assessed from skeletal maturation of the knee and dental development was assessed from schedules of tooth formation. Discrepancies between physiological age (skeletal and dental age) and chronological age were used as a measure of developmental status. A positive score indicates that physiological age is in advance of chronological age, whereas a negative score indicates the reverse. Two socioeconomic groups, one of low and the other of high socioeconomic status, were created based on the occupation of the father and on the place of residence, and developmental status was compared between the two socioeconomic groups. Results confirm previous studies by showing that dental development is less affected by environmental insults than skeletal maturation. While socioeconomic differences in skeletal maturation range from 1.20 to 1.22 years (15-18% of chronological age), socioeconomic differences in dental maturation range from 0.51 to 0.53 years (4-9% of chronological age). Compared to a previous study, results also suggest that skeletal maturation is more affected than skeletal growth. Additionally, an adaptation of the radiographic atlas of skeletal development of the knee is proposed for use with dry skeletal material.
Article
Blinded. Examination of a new radiologic interpretation technique for distinguishing osteoporotic fractures from Scheuermann disease. STUDY OF BACKGROUND DATA: Osteoporotic vertebral fractures are a major clinical problem. A variety of empirically-derived standards have been suggested for their recognition, but the accepted limits for normal variation have been somewhat arbitrary. This report presents and examines a new radiologic technique for distinguishing osteoporotic thoracic vertebral fractures from Scheuermann disease. Vertebral body height measurements (anterior, middle, and posterior) of thoracic vertebrae T6-T10 in 44 individuals with osteoporotic fractures, 28 individuals with Scheuermann disease and a control group of 120 individuals with unaffected vertebrae, were taken from lateral chest radiographs and measured by a digital caliper. For each vertebra, 4 indexes were calculated: 3 primary derivatives; anterior height/posterior height; anterior height/mid height (A/M); mid height/posterior height (M/P); and a secondary derivate index (A/M)/(M/P). Qualitative analysis was subsequently carried out, using lateral spine radiographs of individuals with osteoporotic vertebral fractures and individuals with Scheuermann disease. Statistical analysis included analysis of variance, paired t tests and t tests. The second derivative (A/M)/(M/P) indexes of thoracic vertebrae T6-T10 were significantly greater in the osteoporosis group than in the control and Scheuermann groups (P < 0.05). Contrary to the control and Scheuermann groups, the M/P indexes (T6-T10) were significantly smaller than the A/M indexes in the osteoporosis group. The anterior height/posterior height indexes (T6-T10) in all 3 groups were statistically indistinguishable. Qualitative analysis showed that the intersection of an anterior-midpoint line and a posterior-midpoint line drawn on the superior vertebral body surface (T6-T10) created an "angle of depression" in the osteoporosis group whereas an "angle of elevation" was identified in the Scheuermann group. Second derivative indexes of vertebral body height parameters allow identification of vertebrae with osteoporotic compression fractures and their distinction from vertebrae with Scheuermann disease.
Article
A recent study (Galtés et al.: Am J Phys Anthropol 135 (2008) 293-300) demonstrated that during pronation, pronator teres exerts a favorable force for radial lateral bending. On the basis of this finding, we hypothesized that the pattern of muscular loading exerted on the radius by this muscle might play a role as a mechanical stimulus involved in radial bowing. The current work relates the hypertrophy of the forearm muscles to the degree of lateral curvature of the radial diaphysis. The analysis is based on an original osteometrical index to estimate radial curvature, and it applies a visual reference method to grade the osteological appearance of 10 entheses of 104 radii from archaeological and contemporary samples. Using these morphological data as an indirect method to measure the association between muscular hypertrophy and bone curvature, this study reveals that the pattern of muscular loading exerted on the apex of the radial shaft by the pronator teres muscle may play an important role as a mechanical stimulus involved in diaphyseal bowing.
Article
Familial occurrence of Scheuermann's juvenile kyphosis is well known, but no specific mode of inheritance has been recognized. We describe five families in which the disease seems to follow and autosomal dominant pattern of inheritance.
Article
A high frequency of abnormalities were noted in radiographic measurements of bone density, microradiography of the iliac crest, serum alkaline phosphatase, urinary hydroxyproline and dietary calcium intake in 12 patients with Scheuermann's juvenile kyphosis. Scheuermann's kyphosis may be a manifestation of generalized skeletal disease which becomes symptomatic during the growth spurt of puberty.
Article
The case histories and gross and microscopic findings of two adolescent patients with Scheuermann's kyphosis demonstrate that the anterior longitudinal ligament is bowstrung across the apex of the hyphosis. The microscopic findings include markedly irregular end plates and end plate disruption with protrusion of disk material into the vertebral body. The ring apophysis does not show avascular necrosis. The intervertebral disk is interpreted as normal both by routine histology and electron microscopy. It is postulated that Scheuermann's kyphosis may be secondary to vertebral osteoporosis occurring during the juvenile period rather than to an intrinsic abnormality in the intervertebral disk or ring apophysis.
Article
In a cadaver-derived skeletal collection of 1,384 thoracolumbar spinal columns, 103 (7.4%) individuals with vertebral changes of Scheuermann's kyphosis were identified. Anterior extension of the vertebral specimens was noted in 94% of affected specimens. No evidence of osteoporosis was noted by single-photon absorptiometric analysis in the affected sample compared with a normal control group. Biopsy specimens from two immature patients obtained at surgery suggested disorganized endochondral ossification similar to that noted in Blount's disease. It was concluded that increased pressure on the anterior margin of the centrum is responsible for histologic and morphologic changes of Scheurermann's kyphosis.
Article
We report a family in which Scheuermann's juvenile kyphosis is present in three successive generations with male to male transmission. This provides further evidence for autosomal dominant inheritance in at least some families with this condition.
Article
The densities of the trabecular bone of two or three lumbar vertebral bodies in twenty adolescents, twelve to eighteen years old, who had Scheuermann disease were measured by quantitative computed tomography. These densities were then compared with those for the same vertebrae of twenty age, sex, and race-matched adolescents who were examined by computed tomography because of trauma. The same scanner and phantom were used in all examinations. Both the adolescents who had Scheuermann disease and the control patients were in good health before the quantitative computed-tomography examination and had not been taking any medications. The density of the trabecular bone density in the patients who had Scheuermann disease was not significantly different (p = 0.28) from that in the controls. There also were no significant differences between the patients and the controls with regard to height, weight, surface area, or body-mass index.
Article
Changes consistent with Scheuermann's kyphosis were noted in 103 specimens (7.4%) of a sample of 1,384 thoracic spines in the Hamann-Todd collection of human skeletons. In 94% of the affected vertebrae, a distinct anterior elongation of the vertebral centrum was present. This anterior extension was composed of mature cancellous bone and was morphologically and roentgenographically different from marginal osteophyte formation. It was not present in any vertebrae of a control group of 50 unaffected spines. Associated findings included vertebral wedging and Schmorl's nodes.
Article
Nineteen adolescent patients who presented with mechanical-type back pain and vertebral changes consisting of intravertebral disc herniation, disc space narrowing, and minimal wedge deformity are described. The symptoms and signs were primarily located at the dorsolumbar junction. A specific strenuous activity or traumatic event was clearly associated with the onset of symptoms in 16 of the 19 patients. Spondylolysis or spondylolisthesis (grade I or II) at L5-S1 was also found in 32% of the patients. Most patients responded well to a program of rest, exercises, salicylates, and temporary avoidance of the particular activity involved. Some required orthoses to obtain relief. No patient had a progressive kyphotic deformity during the follow-up period. The relationship of this condition to increased stresses applied to the immature spine, particularly in a preflexed posture, is emphasized.
Article
A prospective study was undertaken to evaluate osteoporosis in Scheuermann's disease. Ten consecutive untreated patients with thoracic Scheuermann's were studied. The mean age was 16 years, 1 month, and the mean kyphosis was 64 degrees. Osteoporosis was quantitated by single and dual photon absorptiometry. Seven age-, sex-, height-, and weight-matched subjects were used as controls. The mean bone mineral density (BMD) of the lumbar spine was 0.975, compared with 1.130 for the control group, significant at P less than 0.025. For patients with a kyphosis greater than 45 degrees, the BMD was 0.913, significant at P less than 0.005. The mean BMD of the femoral neck was 1.00, compared with 1.22, significant at P less than 0.005. For patients with a kyphosis greater than 45 degrees, the femoral neck BMD is 0.983, significant at P less than 0.005. The BMD of the radius by single photon absorptiometry was 0.689, compared with 0.748 in the controls, which was not significant. In patients with a kyphosis greater than 45 degrees, the BMD was 0.655, which is significant at P less than 0.01. A highly significant association exists between osteoporosis and Scheuermann's disease. Further investigation is indicated to determine the role of medical management in the treatment of these patients.
Article
Hemi-atlas is a rare congenital anomaly in the formation of the first cervical vertebra. It may cause a rather severe and progressive torticollis. When a child is young, the neck, despite the deformity, is flexible and the torticollis can be passively corrected. However, in some patients it becomes increasingly severe and fixed. I describe the findings in seventeen patients, seven of whom were operated on between 1975 and 1983. Treatment with a brace was shown to be ineffective. In patients with severe deformities, fusion of the upper part of the cervical spine is recommended. Fusion was obtained in all seven patients in whom it was attempted, and there was good postural correction in all. Early operation is recommended if the deformity is increasing. Gradual correction in a halo cast followed by posterior fusion is recommended as the treatment of choice in patients with severe torticollis.
Article
In a prospective study, 62 girls who consulted the paediatric department because of tall stature were examined for spinal deformities. Thirteen cases of scoliosis measuring 10 degrees or more were found. Eighteen girls had a thoracic kyphosis of more than 40 degrees and 11 had additional vertebral abnormalities indicating Scheuermann's disease. the incidence of scoliosis and Scheuermann's disease was much higher in our material than normal. © 1985 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted.
Article
Scheuermann's juvenile kyphosis may be considered a form of vertebral osteochondrosis. Although the etiology remains unknown, the ultimate effect is a disorderliness of vertebral growth in the growth plate cartilage. The biomechanical effects of increased kyphosis on saggital plane deformity, especially in a growing child, serve to aggravate this deformity.
Article
Unlabelled: Histological and histochemical studies of the spine of a sixteen-year-old boy with juvenile kyphosis who was killed in an automobile accident showed abnormal cartilage in extensive areas of the vertebral and growth plates of the involved vertebrae. In these areas the cartilage matrix was loose, strongly positive when stained with alcian blue and weakly positive to periodic acid-Schiff, and it contained numerous chondrocytes. Some chondrocytes were irregularly shaped and others were in clusters. Vertebral bone growth was stunted under the areas of abnormal vertebral and growth plates. The ossification in the ring apophyses was irregular in areas of abnormal cartilage plate, but necrotic bone was not seen. Schmorl nodes had formed where areas of abnormal cartilage plate adjoining the nucleus pulposus had collapsed, allowing the disc material to herniate into the vertebral body. Clinical relevance: The defective vertebral-bone formation in juvenile kyphosis appears to result from abnormal vertebral and growth-plate cartilage. The kyphosis and presumably also the cartilage abnormality can be improved during the florid stage of the disease by decreasing the postural load on the anterior part of the vertebrae with the use of a proper brace.