Camptocormia

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A patient with camptocormia

Camptocormia also known as bent spine syndrome is a usually organic disorder characterised by marked flexion (greater than 45 degrees) of the thoracolumbar spine that increases during the day and completely disappears when supine.

Terminology

The term comes from the Greek words "to bend" (kamptō) and "trunk" ("trunk").

Aetiology

There are two competing hypothesis, one is that it has a CNS cause, and the other that it has a PNS cause. In the CNS hypothesis the affected area is the striatum and its projections to the reticulospinal tract or thalamus. In the PNS hypothesis there is myopathy of the antigravity spine extension muscles. It only rarely has a psychiatric origin.[1]

Epidemiology

In those with Parkinson's disease and camptocormia there is a male predominance, older age, longer duration of disease, and autonomic symptoms.[2]

Clinical Features

As the day goes on or during walking there is a progressive marked flexion of the thoracolumbar spine. It is relieved by sitting and lying supine. It can also be relieved volitionally by extending the trunk when the patient leans against a wall. There may be associated lateral deviation of the trunk. In two thirds of patients there is a lumbar or thoracolumbar scoliosis.[2]

The total camptocormia angle is measured according to two lines: the line between the lateral malleolus to the L5 spinous process, and the line between the L5 to C7 spinous processes.

Treatment

Treatment is usually unrewarding. Where possible treatment should be directed to the underlying cause. Botox to the external oblique muscles, spinal cord stimulation, and deep brain stimulation have been trialed in case reports.

Further Reading

References

  1. Finsterer, Josef; Strobl, Walter (2010). "Presentation, etiology, diagnosis, and management of camptocormia". European Neurology. 64 (1): 1–8. doi:10.1159/000314897. ISSN 1421-9913. PMID 20634620.
  2. 2.0 2.1 Benatru, I.; Vaugoyeau, M.; Azulay, J.-P. (2008-12). "Postural disorders in Parkinson's disease". Neurophysiologie Clinique = Clinical Neurophysiology. 38 (6): 459–465. doi:10.1016/j.neucli.2008.07.006. ISSN 0987-7053. PMID 19026965. Check date values in: |date= (help)

Literature Review