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

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 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 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 DOI: https://doi.org/10.4184/asj.2013.7.3.222

Barinov VS, Malchenko OV. 2013. Extrapulmonary tuberculosis. Spec Lit: St. Petersburg.

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

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

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

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

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 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 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 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 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.

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

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

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 DOI: https://doi.org/10.3406/paleo.1996.4639

Galinskaya LA. 2013. Tuberculosis. Prevention and treatment. Phoenix: Rostov-on-Don.

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 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 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 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.

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 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.

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 DOI: https://doi.org/10.1097/BRS.0b013e31827300dc

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

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 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 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 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. 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 DOI: https://doi.org/10.1080/17453670810016678

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

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. DOI: https://doi.org/10.18384/2310-676X-2022-5-115-141

Kornev PG. 1953. Kostno-articular tuberculosis. Medgiz: Moscow.

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

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

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.

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 DOI: https://doi.org/10.1002/oa.2845

Larsen CS. 1997. Bioarchaeology: Interpreting Behavior from the Human Skeleton. Cambridge University Press, UK: Cambridge. 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 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 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 DOI: https://doi.org/10.1002/ajpa.1330680105

Lovell NC. 1997. Trauma analysis in paleopathology. Am J Phys Anthropol 105(25): 139–170. 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.

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 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.

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

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 DOI: https://doi.org/10.1177/230949900501300305

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

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 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.

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 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 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.

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.

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.

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

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

Rokhlin DG. 1965. Diseases of ancient people. Moscow.

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 DOI: https://doi.org/10.1093/clinids/1.5.754

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

Talantov VA. 1961. Morphological characteristics of tuberculosis of the spine. Archiv pathol 9: 25.

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 DOI: https://doi.org/10.1016/j.ijpp.2019.03.002

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

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 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 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 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. 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 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 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 DOI: https://doi.org/10.1111/j.1574-6968.2002.tb11298.x