A case of spinal tuberculosis from the middle ages in Transylvania (Romania).

By London Spine
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A case of spinal tuberculosis from the middle ages in Transylvania (Romania).

Spine (Phila Pa 1976). 2012 Dec 1;37(25):E1598-601

Authors: Hajdu T, Donoghue HD, Bernert Z, Fóthi E, Kővári I, Marcsik A

Abstract
STUDY DESIGN: Case report.
OBJECTIVE: To characterize the paleopathology presented in the skeleton of a 45- to 50-year-old man indicative of tuberculous spondylitis and to confirm by the detection of ancient DNA.
SUMMARY OF BACKGROUND DATA: Tuberculosis (TB) is an infectious disease prevalent in both present and ancient human populations. The disease is primarily located within the lungs; although characteristic bone lesions can lead to a clear diagnosis, skeletal TB occurs in only 5% to 6% of TB infections, even in historical cases. In addition, the visual appearance of human skeletal remains may be influenced by the environmental conditions at the burial site. However, it is important to recognize ancient skeletal TB because it can provide important data on the history of Mycobacterium tuberculosis and give a unique opportunity for physicians to observe the natural outcome of the infection of the preantibiotic era.
METHODS: Paleopathological analysis was carried out using careful visual observation supported by ancient DNA analysis. Approximately 60 mg of bone powder from rib fragments was examined and DNA from the M. tuberculosis complex was detected by polymerase chain reaction (PCR) targeting specific genetic loci of the IS6110 and IS1081 regions.
RESULTS: The skeleton is part of a human osteoarchaeological collection (n = 274) from the 12th- to 13th-century Transylvanian archaeological site of Peteni, in modern-day Romania. The individual, a 45- to 50-year-old man, showed gross pathology typical of tuberculous spondylitis. The paleopathological diagnosis was supported by analysis for M. tuberculosis complex ancient DNA.
CONCLUSIONS: This case demonstrates that TB was present in Transylvania (Romania) during the 12th and 13th centuries and adds to the growing body of knowledge on the history of this disease.

PMID: 22976345 [PubMed – in process]

[Percutaneous kyphoplasty in hyperextension position for treatment of middle and late period Kümmell disease].

By London Spine
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[Percutaneous kyphoplasty in hyperextension position for treatment of middle and late period Kümmell disease].

Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2012 Apr;26(4):411-5

Authors: Zhang Y, Yang H, Liu Y, Zhou F, Deng X, Luo W, Chen L

Abstract
OBJECTIVE: To evaluate the feasibility and effectiveness of percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease.
METHODS: Between May 2003 and February 2009, 17 patients with Kümmell disease (6 at stage II, 11 at stage III) were treated with percutaneous kyphoplasty in hyperextension position. There were 5 males and 12 females with an average age of 71 years (range, 55-85 years). The involved vertebral bodies were T10 in 1 case, T11 in 3 cases, T12 in 7 cases, L1 in 4 cases, L2 in 1 case, and T12, L1 in 1 case by X-ray, CT, and MRI examinations. The effectiveness was determined by the visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The height and the kyphotic Cobb angle of the involved vertebral body were measured pre- and postoperatively.
RESULTS: The operation was successfully completed in all the patients, and the incisions healed by first intention. Pain was alleviated or eliminated within 48 hours after operation; no spinal nerves injury or pulmonary embolism occurred. One patient had cement leakage to the adjacent disc, who did not manifest any clinical symptoms. Thirteen patients were followed up 24 to 56 months (mean, 32 months). The VAS score, ODI, anterior and medial vertebral height, kyphotic Cobb angle of involved vertebral body were improved significantly at 1 week after operation and at last follow-up (P < 0.05), there was no significant difference between at 1 week after operation and at last follow-up (P > 0.05). Adjacent vertebral fracture occurred in 1 patient at 6 months after operation and was cured after percutaneous kyphoplasty.
CONCLUSION: Percutaneous kyphoplasty in hyperextension position for treatment of stage II or III Kümmell disease can relieve back pain, improve viability, decrease Cobb angle, and retain the vertebral body height and spinal alignment. The general condition of the patient is needed to be evaluated and the operation indication should be controlled strictly.

PMID: 22568318 [PubMed – indexed for MEDLINE]