The Many Facets of Spine Pathology

: A Review and Evaluation of Approaches in Biological Anthropology and their Current and Future Applications

Abstract

Degenerative diseases of the spine are amongst the most common lesions seen in human skeletal remains and comprise a large area of research within bioarchaeology. Data from such studies can provide an insight into the lifestyle of past populations. To date there have been few attempts to standardise the recording of these lesions, with even less work into establishing inter observer reliability of methods. This study reviews clinical and archaeological literature to establish the scope of diagnostic criteria for different degenerative spinal diseases, before exploring working practices to identify and record these diseases within bioarchaeology. Three approaches were undertaken:

1.A Questionnaire: This asked academics and practitioners within bioarchaeology to describe the methods they used to identify and record pathological vertebral lesions, before describing changes they would look for in osteoarthritis, degenerative disc disease, ankylosing spondylitis, and diffuse idiopathic skeletal hyperostosis. Qualitative questions were complemented by sections asking respondents to rank individual disease characteristics. Rankings were analysed with Friedman testing in SPSS, followed by post hoc analysis with Wilcoxon signed-rank tests and Bonferroni correction.
2.An online interobserver study: This included student and non-student practitioners and tested the reliability of commonly cited methods posed by Buikstra and Ubelaker (1994), Rogers and Waldron (1995), and Sager (1969) for identifying and recording vertebral osteoarthritis and degenerative disc disease. It was undertaken using photographs of skeletonised human vertebrae. Results were analysed using Krippendorff’s Alpha in RStudio.
3.An analysis of bioarchaeological literature: This was carried out using unpublished archaeological reports, doctoral theses, and published literature. This study was undertaken in NVivo and combined qualitative analysis of the themes and contents of the literature, as well as qualitatively analysing trends in terminology and disease reporting temporally and geographically.

Results of the questionnaire showed there were disparities between the methods and terminology used to identify and describe spinal joint diseases. Some significant differences were seen in the ranks applied to disease characteristics, with osteophytes and porosity consistently ranked as the most important lesions in degenerative disc disease. When analysing characteristics of ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis differences were less significant and there was a lack of agreement as to which characteristics were most diagnostic of the disease. The interobserver study showed all three methods commonly cited within the literature had low interobserver reliability. The highest reliability seen was A=0.640 for the Sager (1969) method. Differences in methods and terminology used were also seen within the literature study. However, the temporal analysis of the literature did show trends in terminology and diagnosis were becoming more standardised. This research has highlighted that there is need for more interobserver testing of currently used methods, and that this must be undertaken before further standardisation of identification and recording methods takes place. Such work will ensure methods are being implemented in the same manner and will in turn facilitate collaboration between commercial and academic spheres, leading to greater understanding of the timeline and progression of spinal joint diseases worldwide.

Date of Award	2022
Original language	English
Awarding Institution	University of Dundee
Supervisor	Alexis Wilkinson (Supervisor) & Diana Swales (Supervisor)