Tuberculous spondylitis: Macromorphological and radiological studies on a skeleton from the Late Iron Age monument of Nor Armavir, Armenia

Anahit Yu. Khudaverdyan; Azat A. Yengibaryan; Simon G. Hmayakyan; Nvart G. Tiratsyan; Margar S. Hmayakyan; Shota A. Vardanyan; Anna P. Antonyan; Vahan R. Kocharyan

doi:10.18778/1898-6773.87.1.08

Authors

Anahit Yu. Khudaverdyan Institute of Archaeology and Ethnography, National Academy of Science, Republic of Armenia https://orcid.org/0000-0002-1458-783X
Azat A. Yengibaryan Department of Medical Biology, Yerevan Mkhitar Heratsi State Medical University, Yerevan, Republic of Armenia
Simon G. Hmayakyan Institute of Archaeology and Ethnography, National Academy of Science, Republic of Armenia https://orcid.org/0000-0003-0191-5395
Nvart G. Tiratsyan Institute of Archaeology and Ethnography, National Academy of Science, Republic of Armenia
Margar S. Hmayakyan Institute of Archaeology and Ethnography, National Academy of Science, Republic of Armenia https://orcid.org/0000-0002-7875-828X
Shota A. Vardanyan Department of Forensic Medicine, Yerevan Mkhitar Heratsi State Medical University, Yerevan, Republic of Armenia
Anna P. Antonyan Institute of Applied Problems of Physics of National Academy of Science, Republic of Armenia
Vahan R. Kocharyan Institute of Applied Problems of Physics of National Academy of Science, Republic of Armenia https://orcid.org/0000-0001-6323-3790

DOI:

https://doi.org/10.18778/1898-6773.87.1.08

Keywords:

Armenia, Late Iron Age, Bioarcheology, Paleopathology, Tuberculous Spondylitis

Abstract

The skeleton in question derives from the Late Iron Age monument of Nor Armavir and was unearthed from burial No. 19. The deceased was buried in an unusual position. In this article, we characterize the pathological bony changes indicative of tuberculous spondylitis. The skeleton was subject to a detailed macroscopic investigation. Besides age at death estimation and sex determination, a careful palaeopathological evaluation was performed on the bone remains. In addition, volumetric (3D) computed tomography was carried out on four lumbar vertebrae (L2–5) to complement the macromorphology-based diagnosis.

Downloads

Download data is not yet available.

References

AlQahtani SJ, Hector MP, Liversidge HM. 2010. Brief Communication: The London Atlas of Human Tooth Development and Eruption. Am J Phys Anthropol 42(3): 481–90. https://doi.org/10.1002/ajpa.21258
View in Google Scholar DOI: https://doi.org/10.1002/ajpa.21258

An HS, Seldomridge JA. 2006. Spinal infections: diagnostic tests and imaging studies. Clin Orthop Relat Res 444: 27–33. https://doi.org/10.1097/01.blo.0000203452.36522.97
View in Google Scholar DOI: https://doi.org/10.1097/01.blo.0000203452.36522.97

Baba H, Tagami A, Adachi S, Hiura T, Osaki M. 2013. Tuberculosis affecting multiple vertebral bodies. Asian Spine J 7: 222–6. https://doi.org/10.4184/asj.2013.7.3.222
View in Google Scholar DOI: https://doi.org/10.4184/asj.2013.7.3.222

Barinov VS, Malchenko OV. 2013. Extrapulmonary tuberculosis. Spec Lit: St. Petersburg.
View in Google Scholar

Bartels P. 1907. Wirbelkaries in der jüngeren Steinzeit. Archiv für Anthropologie (N. F.) 6: 233.
View in Google Scholar

Brothwell DR. 1991. Digging up Bones. The Excavation, Treatment and Study of Human Skeletal Remains, third ed. Cornell University Press, Ithaca: New York.
View in Google Scholar

Buikstra JE, Beck LA. 2006. Bioarchaeology: The Contextual Analysis of Human Remains. Academic Press: New York.
View in Google Scholar

Buikstra JE, Ubelaker DH. 1994. Standards for Data Collection From Human Skeletal Remains. Arkansas Archaeological Survey: Fayetteville.
View in Google Scholar

Burrill J, Williams C, Bain G, Conder G, Hine AL, Misra RR. 2007. Tuberculosis: a radiologic review. Radiographics 27(5): 1255–1273. https://doi.org/10.1148/rg.275065176
View in Google Scholar DOI: https://doi.org/10.1148/rg.275065176

Carter JD, Hudson AP. 2009. Reactive arthritis: Clinical aspects and medical management. Rheum Dis Clin North Am 35(1): 21–44. https://doi.org/10.1016/j.rdc.2009.03.010
View in Google Scholar DOI: https://doi.org/10.1016/j.rdc.2009.03.010

Cordero M, Sanchez I. 1991. Brucellar and tuberculous spondylitis. A comparative study of their clinical features. J Bone Joint Surg Br 73: 100–103. https://doi.org/10.1302/0301-620X.73B1.1991738
View in Google Scholar DOI: https://doi.org/10.1302/0301-620X.73B1.1991738

Cottle L, Riordan T. 2008. Infectious spondylodiscitis. J Infect 56(6): 401–412. https://doi.org/10.1016/j.jinf.2008.02.005
View in Google Scholar DOI: https://doi.org/10.1016/j.jinf.2008.02.005

Cox M, Mays S. 2000. Human Osteology in Archaeology and Forensic Science. Cambridge: Cambridge University Press.
View in Google Scholar

Darums VY. 1970. Diseases and healing in the ancient Baltics. Zinatne: Riga.
View in Google Scholar

Dyachenko VA. 1958. X-ray diagnostics of diseases of bones and joints. Medgiz: Moscow.
View in Google Scholar

El-Najjar M, Al-Sarie I, Al-Shiyab A. 1996. Cases of tuberculosis at ‘Ain Ghazal, Jordan. Paléorient 22: 123–8. https://doi.org/10.3406/paleo.2003.4758
View in Google Scholar DOI: https://doi.org/10.3406/paleo.1996.4639

Galinskaya LA. 2013. Tuberculosis. Prevention and treatment. Phoenix: Rostov-on-Don.
View in Google Scholar

Gladman DD. 2005. Psoriatic arthritis: Epidemiology, clinical features, course, and outcome. Ann Rheum Dis 64(suppl_2): ii14–ii17. https://doi.org/10.1136/ard.2004.032482
View in Google Scholar DOI: https://doi.org/10.1136/ard.2004.032482

Gouliouris T, Aliyu SH, Brown NM. 2010. Spondylodiscitis: update on diagnosis and management. J Antimicrob Chemother 65(3): 11–24. https://doi.org/10.1093/jac/dkq303
View in Google Scholar DOI: https://doi.org/10.1093/jac/dkq303

Grassi W, De Angelis R, Lamanna G, Cervini C. 1998. The clinical features of rheumatoid arthritis. Eur J Radiol 27: S18–S24. https://doi.org/10.1016/s0720-048x(98)00038-2
View in Google Scholar DOI: https://doi.org/10.1016/S0720-048X(98)00038-2

Gratsiansky VP, Khokhlov DK. 1966. Diagnosis of initial forms of osteoarticular tuberculosis. Medicine: Leningrad.
View in Google Scholar

Guo H, Lan S, He Y, Tiheiran M, Liu W. 2021. Diferentiating brucella spondylitis from tuberculous spondylitis by the conventional MRI and MR T2 mapping: a prospective study. Eur J Med Res 26: 125–132. https://doi.org/10.1186/s40001-021-00598-4
View in Google Scholar DOI: https://doi.org/10.1186/s40001-021-00598-4

Guseva VN, Dolenko OV, Nekachalova AZ, Titarenko OT, Yakunova OA, Potapenko EI, Novikova NS. 2006. Clinical X-ray and laboratory features of tuberculosis and osteomyelitis of the spine. Probl Tuberk Bolezn Legk 11: 9–13.
View in Google Scholar

Hajdu T, Donoghue HD, Bernert Z, Fóthi E, Kővári I, Marcsik A. 2012. A case of spinal tuberculosis from the middle ages in Transylvania (Romania). Spine 37(25): E1598–601. https://doi.org/10.1097/BRS.0b013e31827300dc
View in Google Scholar DOI: https://doi.org/10.1097/BRS.0b013e31827300dc

Hanáková H, Stloukal M. 1966. Staroslovanské pohfebiste v Josefove: Antropologicky rozbor. Academia: Praha.
View in Google Scholar

Hershkovitz I, Donoghue HD, Minnikin DE, Besra GS, Lee OY, Gernaey AM, Galili E, Eshed V, Greenblatt CL, Lemma E, Bar-Gal GK, Spigelman M. 2008. Detection and molecular characterization of 9,000-year-old Mycobacterium tuberculosis from a Neolithic settlement in the Eastern Mediterranean. PLoS One 3: e3426. https://doi.org/10.1371/journal.pone.0003426
View in Google Scholar DOI: https://doi.org/10.1371/journal.pone.0003426

Hlavenková L, Teasdale MD, Gábor O, Nagy G, Beňuš R, Marcsik A, Pinhasi R, Hajdu T. 2015. Childhood bone tuberculosis from Roman Pécs, Hungary. Homo 66(1): 27–37. https://doi.org/10.1016/j.jchb.2014.10.001
View in Google Scholar DOI: https://doi.org/10.1016/j.jchb.2014.10.001

Huang QS, Zheng C, Hu Y, Yin X, Xu H, Zhang G, Wang Q. 2009. One-stage surgical management for children with spinal tuberculosis by anterior decompression and posterior instrumentation. Int Orthop 33(5): 1385–1390. https://doi.org/10.1007/s00264-009-0758-5
View in Google Scholar DOI: https://doi.org/10.1007/s00264-009-0758-5

Jankauskas R. 1998. History of human tuberculosis in Lithuania: possibilities and limitations of paleoosteological evidences. Bulletins et Mémoires de la Société d’anthropologie de Paris (Nouvelle Série) 10(3–4): 357–374.
View in Google Scholar DOI: https://doi.org/10.3406/bmsap.1998.2524

Karadimas EJ, Bunger C, Lindblad BE, Hansen ES, Høy K, Helmig P, Kannerup AS, Niedermann B. 2008. Spondylodiscitis. A retrospective study of 163 patients. Acta Orthop 79: 650–659. https://doi.org/10.1080/17453670810016678
View in Google Scholar DOI: https://doi.org/10.1080/17453670810016678

Khudaverdyan AYu. 2005. Atlas of paleopatological findings in the territory of Armenia. Van Aryan: Yerevan.
View in Google Scholar

Khudaverdyan AYu, Hmayakyan SG, Tiratsyan NG, Hmayakyan MS. 2022. Paleoanthropology and Paleopatology of Bone Remains from the 7th Century BC Burials Found in the Nor Armavir Burial Ground (Armenia). Bulletin of the Moscow Region State University 5: 115–141.
View in Google Scholar DOI: https://doi.org/10.18384/2310-676X-2022-5-115-141

Kornev PG. 1953. Kostno-articular tuberculosis. Medgiz: Moscow.
View in Google Scholar

Kotze D, Erasmus L. 2006. MRI findings in proven Mucobacterium tuberculosis (TB) spondylitis. SA Journal of Radiology 6: 6–12.
View in Google Scholar DOI: https://doi.org/10.4102/sajr.v10i2.176

Krasnobaev TP. 1950. Bone and joint tuberculosis in children. Medgiz: Moscow.
View in Google Scholar

Kyselicová K, Šebest L, Beňuš R, Bognár C, Šarkan M, Dörnhöferová M. 2015. Skeletal manifestation of tuberculosis in the medieval population of Borovce (8th–12th century AD, Slovakia) in relationship to the occurrence of long bone changes and cribra orbitalia. Česká antropologie 65(2): 16–22.
View in Google Scholar

Larentis O, Tonina E, Tesi C, Rossetti C, Gorini I, Ciliberti R, Licata M. 2020. 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. Int J Osteoarchaeol 30: 180–196. https://doi.org/10.1002/oa.2845
View in Google Scholar DOI: https://doi.org/10.1002/oa.2845

Larsen CS. 1997. Bioarchaeology: Interpreting Behavior from the Human Skeleton. Cambridge University Press, UK: Cambridge.
View in Google Scholar DOI: https://doi.org/10.1017/CBO9780511802676

Lee KH, Goo JM, Lee SM, Park CM, Bahn YE, Kim H, Song YS, Hwang EJ. 2015. Digital Tomosynthesis for Evaluating Metastatic Lung Nodules: Nodule Visibility, Learning Curves, and Reading Times. Korean J Radiol 16(2): 430–439. https://doi.org/10.3348/kjr.2015.16.2.430
View in Google Scholar DOI: https://doi.org/10.3348/kjr.2015.16.2.430

Liu X, Li H, Jin C, Niu G, Guo B, Chen Y, Yang J. 2018. Diferentiation between brucellar and tuberculous spondylodiscitis in the acute and subacute stages by MRI: a retrospective observational study. Acad Radiol 25: 1183–9. https://doi.org/10.1016/j.acra.2018.01.028
View in Google Scholar DOI: https://doi.org/10.1016/j.acra.2018.01.028

Lovejoy CO. 1985. Dental wear in the Libben population: its functional pattern and role in the determination of adult skeletal age at death. Am J Phys Anthropol 68: 47–56. https://doi.org/10.1002/ajpa.1330680105
View in Google Scholar DOI: https://doi.org/10.1002/ajpa.1330680105

Lovell NC. 1997. Trauma analysis in paleopathology. Am J Phys Anthropol 105(25): 139–170.
View in Google Scholar DOI: https://doi.org/10.1002/(SICI)1096-8644(1997)25+<139::AID-AJPA6>3.0.CO;2-#

McKinley JI. 2004. Compiling a skeletal inventory: disarticulated and commingled remains. In: M Brickley, JI McKinley, editors. Guidelines to the Standards for Recording Human Remains. BABAO. 14–17.
View in Google Scholar

Mwachaka PM, Ranketi SS, Nchafatso OG, Kasyoka BM, Kiboi JG. 2011. Spinal tuberculosis among human immunodeficiency virusnegative patients in a Kenyan tertiary hospital: a 5-year synopsis. Spine J 11(4): 265–269. https://doi.org/10.1016/j.spinee.2011.01.033
View in Google Scholar DOI: https://doi.org/10.1016/j.spinee.2011.01.033

Musaev ShM. 2000. Diagnosis and complex treatment of osteomyelitis of the spine. Dissertation of candidate of medical sciences. Kemerovo.
View in Google Scholar

Mushkin AYu. 2006. Bone and joint tuberculosis in children: current situation and prognosis. Tuberculosis and lung diseases 11: 13–16.
View in Google Scholar

Nather A, David V, Hee HT, Thambiah J. 2005. Pyogenic vertebral osteomyelitis: a review of 14 cases. J Orthop Surg (Hong Kong) 13: 240–244. https://doi.org/10.1177/230949900501300305
View in Google Scholar DOI: https://doi.org/10.1177/230949900501300305

Nemeskéri J, Harsányi L. 1959. Die Bedeutung paläopathologischer Untersuchungen für die historische Anthropologie. Homo 10: 203–226.
View in Google Scholar

Nene A, Bhojraj S. 2005. Results of nonsurgical treatment of thoracic spinal tuberculosis in adults. Spine J 5: 79–84. https://doi.org/10.1016/j.spinee.2004.05.255
View in Google Scholar DOI: https://doi.org/10.1016/j.spinee.2004.05.255

Pálfi G, Bereczki Z, Ortner DJ, Dutour O. 2012. Juvenile cases of skeletal tuberculosis from the Terry Anatomical Collection (Smithsonian Institution, Washington, D.C.,USA). Acta Biol Szeged 56: 1–12.
View in Google Scholar

Pereira CE, Lynch JC. 2005. Spinal epidural abscess: an analysis of 24 cases. Surg Neurol (Suppl 1) 63: 26–29. https://doi.org/10.1016/j.surneu.2004.09.021
View in Google Scholar DOI: https://doi.org/10.1016/j.surneu.2004.09.021

Phenice TW. 1969. A newly developed visual method of sexing the os pubis. Am J Phys Anthropol 30: 297–302. https://doi.org/10.1002/ajpa.1330300214
View in Google Scholar DOI: https://doi.org/10.1002/ajpa.1330300214

Pirpilashviln PM. 1954. On the study of diseases of the bone system on the archaeological materials of the Samtavroi burial ground. Reports of the Academy of Sciences of the Georgian SSR XV (8): 551–559.
View in Google Scholar

Pirpilashvili PM. 1956. Traces of some diseases according to paleoanthropological materials. Reports of the Academy of Sciences of the Georgian SSR XVII (4): 369–376.
View in Google Scholar

Ratobylsky GV, Khovrin VV, Kamalov YR, Baturin OV, Flerov KE, Mozhokina GN. 2012. Clinical and radiation diagnostics of spinal tuberculosis at the present stage. Diagnostic and interventional radiology 6(1): 19–27.
View in Google Scholar

Reinberg SA. 1955. X-ray diagnostics of diseases of bones and joints. Medgiz: Moscow.
View in Google Scholar

Rogers J, Waldron T. 1995. A field guide to joint disease in archaeology. New York: John Wiley & Sons, Inc.
View in Google Scholar

Rokhlin DG. 1965. Diseases of ancient people. Moscow.
View in Google Scholar

Sapico FL, Montgomerie JZ. 1979. Pyogenic vertebral osteomyelitis: report of nine cases and review of the literature. Rev Infect Dis 1: 754–776. https://doi.org/10.1093/clinids/1.5.754
View in Google Scholar DOI: https://doi.org/10.1093/clinids/1.5.754

Smith EG, Dawson WR. 1924. Egyptian Mummies. George Allen & Unwin Ltd: London.
View in Google Scholar

Talantov VA. 1961. Morphological characteristics of tuberculosis of the spine. Archiv pathol 9: 25.
View in Google Scholar

Tesi C, Giuffra V, Fornaciari G, Larentis O, Motto M, Licata M. 2019. A case of erosive polyarthropathy from Medieval northern Italy (12th–13th centuries). Int J Paleopathol 25: 20–29. https://doi.org/10.1016/j.ijpp.2019.03.002
View in Google Scholar DOI: https://doi.org/10.1016/j.ijpp.2019.03.002

Tikhodeev SA, Vishnevsky AA. 2004. Nonspecific osteomyelitis of the spine. Spbmapo: St. Petersburg.
View in Google Scholar

Torres-Gonzalez P, Cervera-Hernandez ME, Martinez-Gamboa A, Garcia-Garcia L, Cruz-Hervert LP, Bobadilla-Del Valle M, Ponce-de Leon A, Sifuentes-Osornio J. 2016. Human tuberculosis caused by Mycobacterium bovis: a retrospective comparison with Mycobacterium tuberculosis in a Mexican tertiary care centre, 2000–2015. BMC Infect Dis 16(1): 657. https://doi.org/10.1186/s12879-016-2001-5
View in Google Scholar DOI: https://doi.org/10.1186/s12879-016-2001-5

Trotter M, Gleser GC. 1958. A reevaluation of estimation of stature based on measurements of stature taken during life and of long bones after death. Am J Phys Anthropol 16: 79–123. https://doi.org/10.1002/ajpa.1330160106
View in Google Scholar DOI: https://doi.org/10.1002/ajpa.1330160106

Turunc TA, Demiroglu YZ, Uncu H, Colakoglu S, Arslan H. 2007. Comparative analysis of tuberculous, brucellar and pyogenic spontaneous spondylodiscitis patients. J Infect 55: 158–163. https://doi.org/10.1016/j.jinf.2007.04.002
View in Google Scholar DOI: https://doi.org/10.1016/j.jinf.2007.04.002

Vasilyev SV, Bulgin DV, Simavonyan KV, Borutskaya SB, Emelyanchik OA, Oganesyan AO, Kartashov SI, Chichaev IA. 2022. Experience in the study of paleopathology of the spine using computed tomography and radiography. Bulletin of Archaeology, Anthropology and Ethnography 3(58): 136–147.
View in Google Scholar DOI: https://doi.org/10.20874/2071-0437-2022-58-3-12

Yang X, Zhang Q, Guo X. 2014. Value of magnetic resonance imaging in brucellar spondylodiscitis. Radiol Med 119: 928–933. https://doi.org/10.1007/s11547-014-0416-x
View in Google Scholar DOI: https://doi.org/10.1007/s11547-014-0416-x

Yoo S, Wu QJ, Godfrey D, Yan H, Ren L, Das S, Lee WR, Yin F-F. 2009. Clinical Evaluation of positioning verification using digital tomosynthesis (DTS) based on bony anatomy and soft tissues for prostate image-guided radiation therapy (IGRT). Int J Radiat Oncol Biol Phys 73(1): 296–305. https://doi.org/10.1016/j.ijrobp.2008.09.006
View in Google Scholar DOI: https://doi.org/10.1016/j.ijrobp.2008.09.006

Zink AR, Reischl U, Wolf H, Nerlich AG. 2002. Molecular analysis of ancient microbial infections. FEMS Microbiology Letters 213(2): 141–147. https://doi.org/10.1111/j.1574-6968.2002.tb11298.x
View in Google Scholar DOI: https://doi.org/10.1111/j.1574-6968.2002.tb11298.x