Hila May

Schmorl’s nodes distribution in the human spine and its possible etiology

Although Schmorl’s nodes (SNs) are a common phenomenon in the normal adult population, their prevalence is controversial and etiology still debatable. The objective was to establish the spatial distribution of SNs along the spine in order to reveal its pathophysiology. In this study, we examined 240 human skeleton spines (T4-L5) (from the Hamann–Todd Osteological Collection) for the presence and location of SNs. To determine the exact position of SNs, each vertebral body surface was divided into 13 zones and 3 areas (anterior, middle, posterior). Our results show that SNs appeared more frequently in the T7-L1 region. The total number of SNs found in our sample was 511: 193 (37.7%) were located on the superior surface and 318 (62.3%) on the inferior surface of the vertebral body. SNs were more commonly found in the middle part of the vertebral body (63.7%). No association was found between the SNs location along the spine and gender, ethnicity and age. This study suggests that the frequency distribution of SNs varies with vertebra location and surface. The results do not lend support to the traumatic or disease explanation of the phenomenon. SNs occurrences are probably associated with the vertebra development process during early life, the nucleus pulposus pressing the weakest part of the end plate in addition to the various strains on the vertebrae and the intervertebral disc along the spine during spinal movements (especially torsional movements).

Ligamentum Flavum Thickness in Normal and Stenotic Lumbar Spines

Study Design. A descriptive computed tomography (CT) study of the ligamentum flavum (LF) thickness in individuals with normal and stenotic lumbar spines. Objective. To establish standards for normal and pathologic range of LF thickness and its asymmetry as indicated in CT images and to examine its association with vertebral body size, age, and gender. Summary of Background Data. LF lines a considerable part of the posterior and lateral walls of the spinal canal and is a major role contributor to spinal canal stenosis. Due to methodologic deficiencies (e.g., small sample size, lack of control for vertebral body size, gender, and age), the normal range of LF thickness is still controversial. Furthermore, data on important aspect of LF thickness such as left-right differences are missing. Methods. Two groups of individuals were studied. The first group included 65 individuals with lumbar spinal stenosis (LSS) (mean age: 66 ± 9.7 years) and the second, 150 individuals (mean age: 52 ± 19 years) without LSS-related symptoms. LF thickness was measured on CT images (Philips Brilliance 64), obtained from axial plane scan at the intervertebral disc level. Measurements were performed at the levels of L3–L4, L4–L5, and L5–S1. Analysis of variance and t test were carried out to evaluate the association between LF thickness and demographic factors. Results. Absolute and relative LF thickness were significantly greater in the LSS group at the levels of L3–L4 and L4–L5 on both sides, compared to control group (P < 0.05). LF thickness was independent of gender (absolute and relative thickness). Even though LF thickness at all levels significantly increases with age, significant changes after the age of 60 occurred only at L3–L4. Significant asymmetry in LF thickness was found at L3–L4 (2.9 ± 0.90 mm on the right vs. 2.76 ± 0.90 mm on the left) and L5–S1 (3.42 ± 1.1 mm on the right vs. 3.22 ± 1.22 mm on the left) (P < 0.05). Conclusion. LF thickness is an age-dependent and gender-independent phenomenon. LF is significantly thicker on the right side. The borderline between normal and pathologic LF thickness should not be set at 4 mm.

Demographical aspects of Schmorl nodes: a skeletal study.

Study Design. A descriptive study of the association between Schmorl nodes (SNs) and gender, ethnic origin, and age in a normal skeletal population. Objectives. To gain reliable data on behavioral patterns of SNs in various human groups shedding light on its etiology. Summary of Background Data. Opinions regarding SNs prevalence in human populations vary greatly (from 5% to 70%). This caveat greatly reduced our ability to recognize the etiology of the phenomenon and understand its clinical significance. Methods. Two hundred forty human skeleton vertebrae (T4–L5) from a normal adult population (divided by gender, ethnicity, and age) were examined for SNs. SNs were defined as depressions with sclerotic margins appearing on the vertebral body surface. Results. One hundred sixteen individuals (48.3%) of the 240 studied manifested SNs along their thoracolumbar spine. SNs are age independent and gender and ethnicity dependent, are significantly more common in males (54.2%) versus females (43%) and more common in European-Americans (60.3%) versus African-Americans (36.7%). Conclusion. SNs are a common phenomenon in the normal adult populations with almost half of the individuals in our sample manifesting at least 1 vertebra with SN. Its demographic characteristics suggest that the phenomenon is not of occupational origin, promoting the notion of genetic background.

Facet joints arthrosis in normal and stenotic lumbar spines.

ABSTRACT: Study Design. A descriptive CT study of lumbar facet joint (FJ) arthrosis in general and spinal stenosis populations.Objective. To reveal the prevalence of FJ arthrosis in general and stenosis populations and to establish its relationship to age and gender.Summary of Background Data. FJ arthrosis is a common radiographic finding and has been suggested as a cause of low back and lower extremity pain. It is also considered a dominant player in the genesis of lumbar spinal stenosis. Although it is well accepted that FJ arthrosis is an age dependent phenomenon, controversies still exist as to its association with gender and its prevalence at different spine levels. Additionally, data on FJ arthrosis frequency in spinal stenosis population are missing.Methods. Two groups were studied. The first included 65 individuals with LSS (mean age 66 ± 10 years) and the second, 150 individuals (mean age 52 ± 19 years) without LSS related symptoms. Both left and right FJ arthrosis for each vertebral level (L3 to S1) were evaluated on CT images (Brilliance 64, Philips Medical System, Cleveland Ohio). Chi-Square, Linear-by-Linear Association and McNemar test were carried out to reveal the correlation between FJ arthrosis and demographic factors (age, gender) and prevalence at different lumbar levels in both stenosis and non-stenosis groups. Additionally, a 2-way ANOVA was used to determine the association between BMI and FJ arthrosis.Results. The rate of FJ arthrosis at L3-4 and L4-5 were significantly higher (P<0.001) in the stenotic group compared to the control. In the control group the prevalence of FJ arthrosis increases cephalo-caudally (L3-L4 = 16%, L4-L5 = 28%, L5-S1 = 55%), whereas in the stenotic group there is a sharp increase from L3-4 (27%) to L4-5 (58%), but not from L4-5 to L5-S1 (55%). No association between FJ arthrosis and gender was noted. Although, mean BMI was significantly smaller in the control group compared to the stenotic group, no association between BMI and facet arthrosis was found. In the general population the prevalence of FJ arthrosis at all three levels was greater for the right side; however, significant difference (P = 0.004) was obtained only for L3-4. In all joints studied, the prevalence of FJ arthrosis increases considerably from the young age cohort (18-39) to the old age cohort (>60). Nevertheless, 10% of the young individuals (18-39) have already manifested FJ arthrosis at L5-S1. No arthrosis at that age was observed at L3-4.Conclusion. FJ arthrosis is an age-dependent and BMI and gender-independent phenomenon. In the general population, the prevalence of FJ arthrosis increases cephalo-caudally with the highest frequency at L5-S1. In the stenotic group, the highest frequency was observed at the two caudal levels; L4-5 and L5-S1. The prevalence of FJ arthrosis was greater for the right side.Study Design. A descriptive CT study of lumbar facet joint (FJ) arthrosis in general and spinal stenosis populations. Objective. To reveal the prevalence of FJ arthrosis in general and stenosis populations and to establish its relationship to age and sex. Summary of Background Data. FJ arthrosis is a common radiographic finding and has been suggested as a cause of low back and lower extremity pain. It is also considered a dominant player in the genesis of lumbar spinal stenosis. Although it is well accepted that FJ arthrosis is an age dependent phenomenon, controversies still exist as to its association with sex and its prevalence at different spine levels. In addition, data on FJ arthrosis frequency in spinal stenosis population are missing. Methods. Two groups were studied. The first included 65 individuals with LSS (mean age = 66 ± 10 yr) and the second, 150 individuals (mean age = 52 ± 19 yr) without LSS related symptoms. Both left and right FJ arthrosis for each vertebral level (L3–S1) were evaluated on CT images (Brilliance 64, Philips Medical System, Cleveland, OH). Chi-square, Linear-by-Linear Association and McNemar test were carried out to reveal the correlation between FJ arthrosis and demographic factors (age, sex) and prevalence at different lumbar levels in both stenosis and nonstenosis groups. In addition, a two-way analysis of variance (ANOVA) was used to determine the association between body mass index (BMI) and FJ arthrosis. Results. The rate of FJ arthrosis at L3–L4 and L4–L5 were significantly higher (P < 0.001) in the stenotic group compared to the control. In the control group the prevalence of FJ arthrosis increases cephalocaudally (L3-L4 = 16%, L4–L5 = 28%, L5–S1 = 55%), whereas in the stenotic group there is a sharp increase from L3–L4 (27%) to L4–L5 (58%), but not from L4–L5 to L5–S1 (55%). No association between FJ arthrosis and sex was noted. Although, mean BMI was significantly smaller in the control group compared to the stenotic group, no association between BMI and facet arthrosis was found. In the general population the prevalence of FJ arthrosis at all three levels was greater for the right side; however, significant difference (P = 0.004) was obtained only for L3–L4. In all joints studied, the prevalence of FJ arthrosis increases considerably from the young age cohort (18–39) to the old age cohort (>60). Nevertheless, 10% of the young individuals (18–39) have already manifested FJ arthrosis at L5–S1. No arthrosis at that age was observed at L3–L4. Conclusion. FJ arthrosis is an age-dependent and BMI and sex independent phenomenon. In the general population, the prevalence of FJ arthrosis increases cephalocaudally with the highest frequency at L5–S1. In the stenotic group, the highest frequency was observed at the two caudal levels; L4–L5 and L5–S1. The prevalence of FJ arthrosis was greater for the right side.

A morphological adaptation of the thoracic and lumbar vertebrae to lumbar hyperlordosis in young and adult females

The lumbar shape in females is thought to be unique, compensating for lumbar hyperlordosis. Yet, the morphological adaptation of various vertebral parameters in the thoracic and lumbar spine to this unique posture in young and adult females has only been partially addressed in the literature. Our aim was to investigate the gender association to vertebral shape in the thoracic and lumbar spine as a possible adaptation to lumbar hyperlordosis in young and adult females. A three-dimensional digitizer was used to measure the vertebral body sagittal wedging, relative spinous process thickness, and relative interfacet width at the T1–L5 level. Two hundred and forty complete, non-pathological skeletons of adults and 32 skeletons of young individuals were assessed. Three major results were found to be independent of age and ethnicity: (a) VB sagittal wedging in females was significantly less kyphotic than males from T9 to L2 (T11 excluded) with a cumulative mean difference of 8.8°; (b) females had a significantly relatively thinner lumbar spinous processes and (c) females had a relatively wider superior interfacet distance (T9–T10 and L1–L4) than males. We conclude that the combination of less kyphotic VB wedging in the lower thoracic and upper lumbar vertebrae, relatively greater interspinous space and larger interfacet width in the lumbar spine in females are key architectural elements in the lumbar hyperlordosis in females and may compensate for the bipedal obstetric load during pregnancy.

Tuberculosis origin: The Neolithic scenario

This paper follows the dramatic changes in scientific research during the last 20 years regarding the relationship between the Mycobacterium tuberculosis complex and its hosts - bovids and/or humans. Once the M. tuberculosis and Mycobacterium bovis genomes were sequenced, it became obvious that the old story of M. bovis evolving into the human pathogen should be reversed, as M. tuberculosis is more ancestral than M. bovis. Nevertheless, the timescale and geographical origin remained an enigma. In the current study human and cattle bone samples were examined for evidence of tuberculosis from the site of Atlit-Yam in the Eastern Mediterranean, dating from 9250 to 8160 (calibrated) years ago. Strict precautions were used to prevent contamination in the DNA analysis, and independent centers used to confirm authenticity of findings. DNA from five M. tuberculosis genetic loci was detected and had characteristics consistent with extant genetic lineages. High performance liquid chromatography was used as an independent method of verification and it directly detected mycolic acid lipid biomarkers, specific for the M. tuberculosis complex. These, together with pathological changes detected in some of the bones, confirm the presence of the disease in the Levantine populations during the Pre-pottery Neolithic C period, more than 8000 years ago.

The earliest modern humans outside Africa

Earliest modern humans out of Africa Recent paleoanthropological studies have suggested that modern humans migrated from Africa as early as the beginning of the Late Pleistocene, 120,000 years ago. Hershkovitz et al. now suggest that early modern humans were already present outside of Africa more than 55,000 years earlier (see the Perspective by Stringer and Galway-Witham). During excavations of sediments at Mount Carmel, Israel, they found a fossil of a mouth part, a left hemimaxilla, with almost complete dentition. The sediments contain a series of well-defined hearths and a rich stone-based industry, as well as abundant animal remains. Analysis of the human remains, and dating of the site and the fossil itself, indicate a likely age of at least 177,000 years for the fossil—making it the oldest member of the Homo sapiens clade found outside Africa. Science, this issue p. 456; see also p. 389 Fossilized mouthparts indicate the presence of Homo sapiens in the Levant 160,000 years ago. To date, the earliest modern human fossils found outside of Africa are dated to around 90,000 to 120,000 years ago at the Levantine sites of Skhul and Qafzeh. A maxilla and associated dentition recently discovered at Misliya Cave, Israel, was dated to 177,000 to 194,000 years ago, suggesting that members of the Homo sapiens clade left Africa earlier than previously thought. This finding changes our view on modern human dispersal and is consistent with recent genetic studies, which have posited the possibility of an earlier dispersal of Homo sapiens around 220,000 years ago. The Misliya maxilla is associated with full-fledged Levallois technology in the Levant, suggesting that the emergence of this technology is linked to the appearance of Homo sapiens in the region, as has been documented in Africa.

Hyperostosis frontalis interna: criteria for sexing and aging a skeleton

Estimation of sex and age in skeletons is essential in anthropological and forensic medicine investigations. The aim of the current study was to examine the potential of hyperostosis frontalis interna (HFI) as a criterion for determining sex and age in forensic cases. Macroscopic examination of the inner aspect of the frontal bone of 768 skulls (326 males and 442 females) aged 1 to 103, which had undergone a head computerized tomography scan, was carried out using the volume rendering technique. HFI was divided into two categories: minor and major. HFI is a sex- and age-dependent phenomena, with females manifesting significantly higher prevalence than males (p < 0.01). In both females and males, prevalence of HFI increases as age increases (p < 0.01). We present herein the probabilities of designating an unknown skull to a specific sex and age cohort according to the presence of HFI (standardized to age distribution in an Israeli population). Moreover, we present the probability of an individual belonging to a specific sex or age cohort according to age or sex (respectively) and severity of HFI. We suggest a valid, reliable, and easy method for sex and age identification of unknown skulls.

Hyperostosis frontalis interna: what does it tell us about our health?

Objectives: To examine whether the prevalence and severity of hyperostosis frontalis interna (HFI) has significantly changed during the past 100 years.

Hyperostosis Frontalis Interna and Androgen Suppression

Although hyperostosis frontalis interna (HFI) has been documented in the medical literature for over 300 years, its etiology remains undetermined. It is generally assumed to be associated with hormonal disturbances of the gonads. The aim of this study was to examine the association between androgen deprivation and development of HFI in males. Two groups of males over 60‐years old were compared: a control group that included 180 healthy males, 45 suffering from benign prostatic hypertrophy (BPH) and a study group of 127 males with prostate cancer: 67 who received complete androgen block treatment, and 60 who received different treatments or none at all. CT head scans were used to identify and classify HFI (Brilliance 64, Philips Medical Systems, slice thickness 3 mm × 1.5 mm). It was found that males who received a complete androgen block manifested significantly higher prevalence of HFI compared to healthy males. However, no significant difference in HFI prevalence was found between males suffering from BPH and healthy males or males with prostate cancer who had not received a complete androgen block. A positive association between length of hormonal treatment and manifestation of HFI was shown. It can be concluded that BPH does not promote development of HFI; males who are hormonally treated for prostate cancer are at a higher risk of developing HFI compared to healthy males; the longer the duration of hormonal treatment, the higher the risk of developing HFI. Anat Rec 293:1333–1336, 2010.