Rare manifestations of spinal tuberculosis in the Robert J. Terry Anatomical Skeletal Collection (National Museum of Natural History, Smithsonian Institution, Washington, DC, USA)

Abstract

Today, osteoarticular tuberculosis (TB) is a rare extrapulmonary manifestation of TB, developing in about 1–3% of patients. Although any part of the skeleton can be affected by tuberculosis, the spine represents the most common site of involvement (~50%). Spinal TB or tuberculous spondylitis typically affects 2 or more contiguous vertebrae, predominantly in the lower thoracic (40–50%) and upper lumbar (35–40%) regions. In the minority of patients (less than 10%), multilevel noncontiguous involvement occurs. By the location of lesions in the vertebra, 5 main types of spinal TB can be distinguished: paradiscal, central, anterior subligamentous, posterior, and articular forms, with the first being the most common type (90–95%). In the palaeopathological literature, the majority of the described spinal TB cases represent the paradiscal form affecting 2 or more contiguous vertebrae in the thoracolumbar region. The aim of our paper is to provide 3 example cases of known age at death, sex, and cause of death from the Terry Collection that show vertebral alterations indicative of rare manifestations of tuberculous spondylitis, and to interpret the observed lesions with regard to their diagnostic value in the palaeopathological practice. Terry No. 468 (23‐year‐old, male, died of pulmonary and spinal TB) exhibited bony changes presumably attributed to the anterior subligamentous form, whereas Terry No. 902 (c. 36‐year‐old, male, died of pulmonary TB) very likely represents the articular and anterior subligamentous types. The vertebral lesions recorded in the skeleton of Terry No. 1124R (49‐year‐old, female, died of pulmonary TB) are suggestive of the paradiscal form with multilevel noncontiguous involvement. Our paper provides palaeopathologists with a stronger basis for identifying tuberculosis in ancient human remains that reveal unusual vertebral alterations resembling that of our cases and, therefore, with a more sensitive means of assessing TB prevalence in past populations.

A probable case of subligamentous tuberculous spondylitis: The concealed body of the Late Modern Period (early 16th century to early 20th century), Franciscan crypt of St. Anthony and St. Eusebius church, Lombardy, Italy

“…In this study, we have presented a new probable case of STBS, a rare form of extrapulmonary TB with significant signs at the level of the spinal elements. In particular, according to Spekker's recent research (Spekker et al, ), TB form is characterized by the anterior and lateral slight erosion, new bone formation of the surface and hypervascularization of the vertebral bodies, groove‐like and deep subspherical erosive lesions and bridges interconnecting the adjacent vertebrae. In addition to that, Azzio No.…”

“…From TB literature, it is a well‐known fact that groups of contiguous vertebrae are often involved. Indeed, the vertebrae are usually interested in both osteoclastic and osteoblastic phenomena (Canci et al, ; Kumar, ; Okazaki et al, ; Spekker et al, ). In particular, erosive lesions in spinal TB cases are often severe and involve the anterior part of the vertebral body with osteolytic foci (Okazaki et al, ; Spekker et al, ).…”

“…As for the fusion of the posterior elements, even though it is not always related to TB (Anderson, ), this feature could be considered, nevertheless, a common feature of TB (Köhler et al, ; Matos, Marques, & Lopes, ; Okazaki et al, ). In her recent work on three individuals of the Terry collection affected by TB, Spekker demonstrates that the morphological criteria available for a TB diagnosis on human skeletal remains could be more than those usually mentioned in literature (Spekker et al, ). Our skeleton shows evidence of a probable Pott's disease, accepted as a pathognomonic evidence of TB infection in palaeopathological record (Aufderheide & Rodriquez‐Martin, ).…”

“…Moreover, it is possible to recognize some non‐specific skeletal changes that can be linked with STBS, according to both clinical and palaeopathological literature. The most significant ones are the presence of small lytic lesions in the posterior vertebral elements (Dawson & Robson Brown, ; Kumar, ; Matos et al, ; Spekker et al, ; Suzuki & Inoue, ), the fusion of the vertebral laminae (Anderson, ; Köhler et al, ; Mariotti et al, ; Okazaki et al, ; Weber, Czarnetzki, & Pusch, ) and the ossification of the radiate ligaments (Formicola, Milanesi, & Scarsini, ; Govender et al, ; Louw, ; Madkour, ; Rubini, Zaio, & Roberts, ).…”

“…From TB literature, it is a well-known fact that groups of contiguous vertebrae are often involved. Indeed, the vertebrae are usually interested in both osteoclastic and osteoblastic phenomena (Canci et al, 2005;Kumar, 2017;Okazaki et al, 2019;Spekker et al, 2018).…”