Morphologic and Clinical Aspects of Pott Disease in Ancient Human Remains: A Scoping Review

The present study is a scoping review of the literature on Pott disease in ancient human remains.

Comprehending the origin and history of Pott disease is relevant to assessing this pathologic condition from an evolutionary perspective.

Tuberculosis (TB) is an ancient pulmonary disease that remains the leading cause of death from a single infectious agent, rating above HIV/AIDS. The disease typically affects the lungs but can also target other anatomic sites. Of those, the most common and characteristic are the skeletal changes involving the spine, such as in Pott disease. Spinal tuberculosis accounts for approximately half of all cases of musculoskeletal tuberculosis. It can lead to loss of function in the lower limbs due to damage to the spinal column. Nevertheless, its origin and evolution are still not fully understood and need further investigation.

The authors investigated the published studies on Pott disease in ancient human remains, intending to survey the literature, map the evidence and identify gaps and future perspectives on TB in paleopathology. The search strategy was conducted between September 2021 and March 2023 using keywords including the terms "Pott disease" OR "tuberculosis" AND "skeletal remains" in PubMed Biomed Central , Scopus , and Google Scholar search engines and biomedical databases. Five hundred and three records were initially identified, and 66 studies were finally included and assessed for qualitative analysis. Finally, the included records were analyzed in terms of non-narrative data, including the type of publication, country of excavation, dating of the sample, the number of human remains, and their details. Furthermore, the type of bone lesion was indicated as well as the diagnostic method if detailed.

Among articles identified, most were classified as original articles, and were published between 2011 and 2020. Close to 77% of the reported records are excavations in Europe and the Near East. Included studies considered a total of 3388 human remains, mostly excavated in archeological sites and necropoles. Interestingly, the reported prevalence was higher among young males and adults.

Although most of the findings are consistent with the literature, since the majority of the human remains were from Europe and the Near Middle East, more research is necessary in other sectors of the world. The suggestion of a male predominance needs to be confirmed and questions about the possible pathognomic role of rib lesions as well Serpes endocranica symmetrica (SES) represent further areas of research that need to be explored.