Abstract
Introduction: The clinical condition was described as Ankylosing Hyperostosis of the Spine by Forestier (19501), was expanded by Resnick (1975) with the Extraspinal Manifestations2. What is the nature of this unique formation, asymptomatic in 90% of cases? Several researchers questioned whether the hyperostosis was physiological or pathological. Initially, in 1985 B.M. Rotschild called it a phenomenon 3. Schlapbach in 1989 found no associated pathological condition 4. Hutton in his Editorial “Hyperostosis…a State not a Disease“ was doubtful 5.
In recent personal observations, protection by ossification was recorded in a severe trauma case and in vertebrae weakened by malignant infiltration.
Methods: A phylogenetic review of the animal world, followed by an ontogenetic study of mammals/ humans, could assist in a decision regarding the nature (physio-or pathological) of the hyperostosis.
Results: The phylogenetic lineage on one side showed the oldest record of hyperostosis in dinosaur (144 million years ago=mya). Ossifications were found in the anterior, lateral, posterior longitudinal ligaments, in C1–C2 transverse ligament. In the other phylogenetic, Hyperostosis was in historic and contemporary mammals.
The next step in this study is in the ontogenetic line of the Humans. The oldest skeleton (Ethiopia, 4.5 mya) showed “bridged vertebrae“. The first definite hyperostosis was in the Shanidar skeleton (Iraq, 40–12,000 BCE) with“flowing osteophytes”. In the historic Humans since 9500 BCE, hyperostosis was found in Europeans, Egyptians, Indians (Chile) and Incas. In the Christian era, hyperostosis was present in Roman-British/ Celt populations, Franks, Saxons, British, Swiss and N. Americans. In the 20th C, it is pandemic.
Discussion: a. Impressions from the animal world: Paleopathology was established as a scientific branch in 1912 (Ruffer), and exemplified its value in understanding the nature of diseases. Moodie questioned the function of the long spinal “bony rods”, considered them with a protective function. Others 6 suggested spinal hyperostosis as induced by “mechanical stress”. Shore7 (1936) described the spondylitis ossificans ligamentorum as due to mechanical strain.
b. Impressions from the Hominid world: The ontogenetic line shows a constant presence of hyperostosis in prehistoric and historic periods. Parallel to human migration from Africa, hyperostosis expanded globally.
c. The theory of logical probability: It is postulated that hyperostosis is a condition, as no pathology (other than inflammatory) could have expanded and persisted in many species along millions of years, as it would have been removed by the rules of the Darwinian Selection. Possibly triggered by strain in younger age, functional in the past, it is today an atavistic older age “condition“, with increased osteoblastic activity in connective tissues of ligaments and tendons. At times it is incidentally discovered and is occasionally excessive. Once presented with clinical manifestations, it becomes defined an illness and should be called the Forestier-Resnick syndrome.
The abstracts were prepared by Dr Robert Moore. Correspondence should be addressed to him at Spine Society of Australia, c/o the Adelaide Centre for Spinal Research, Institute of Medical and Veterinary Science, PO Box 14, Rundle Mall, Adelaide SA 500, Australia.
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