Rare manifestations of spinal tuberculosis in the Robert J. Terry Anatomical Skeletal Collection (National Museum of Natural History, Smithsonian Institution, Washington, DC, USA)
Spekker, Olga, Hunt, David R., Váradi, Orsolya Anna, Berthon, William, Molnár, Erika and Pálfi, György
Abstract
Today, osteoarticular tuberculosis (TB) is a rare extrapulmonary manifestation of TB, developing in about 1–3%25 of patients. Although any part of the skeleton can be affected by tuberculosis, the spine represents the most common site of involvement (~50%25). Spinal TB or tuberculous spondylitis typically affects 2 or more contiguous vertebrae, predominantly in the lower thoracic (40–50%25) and upper lumbar (35–40%25) regions. In the minority of patients (less than 10%25), 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%25). 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.
