What is camptocormia (bent spine), a condition characterized by an abnormal forward flexion of the thoracolumbar spine?

From the Guidelines

Camptocormia is a condition that requires a comprehensive treatment approach, including physical therapy, medication, and supportive devices, with the goal of improving posture, reducing symptoms, and enhancing quality of life. The condition is characterized by severe forward bending of the spine that worsens during standing or walking and improves when lying down, and is often associated with Parkinson's disease, dystonia, myopathy, or psychological factors. Treatment depends on the underlying cause, but typically includes a combination of physical therapy, medication, and sometimes supportive devices. For Parkinson's-related camptocormia, optimizing dopaminergic therapy with medications like levodopa may help, though response varies 1. Deep brain stimulation might benefit selected patients. For dystonic camptocormia, botulinum toxin injections into overactive paraspinal muscles can provide relief. Myopathic causes may respond to immunosuppressive therapy if inflammatory in nature.

Some key points to consider in the treatment of camptocormia include:

• Physical therapy is crucial in all cases to strengthen core and back muscles, improve posture, and maintain flexibility 1
• Supportive orthoses or braces may help patients maintain a more upright posture during daily activities
• Early intervention is important as longstanding camptocormia can lead to fixed deformities from muscle contractures and spinal changes, making treatment more challenging over time
• A comprehensive treatment approach should prioritize morbidity, mortality, and quality of life as the primary outcomes, and should be guided by the most recent and highest quality evidence available 1

In terms of specific interventions, the evidence suggests that:

• Acupuncture and acupressure may be useful in managing chronic low back pain, but their effectiveness in treating camptocormia is unclear 1
• Exercise and physical therapy are essential components of a comprehensive treatment approach for camptocormia, and should be tailored to the individual patient's needs and abilities 1
• Medications such as levodopa and botulinum toxin may be useful in managing specific underlying causes of camptocormia, but should be used under the guidance of a qualified healthcare professional 1

From the Research

Definition and Characteristics of Camptocormia

• Camptocormia is a disabling pathological, non-fixed, forward bending of the trunk 2
• It is characterized by an abnormal flexion of the trunk, appearing in standing position, increasing during walking and abating in supine position 3
• The clinical definition of camptocormia should include the subjectively perceived inability to stand upright, occurrence of back pain, typical individual complaints, and need for walking aids and compensatory signs 2

Etiologies of Camptocormia

• Camptocormia is most frequently encountered in movement disorders (PD and dystonia) and muscles diseases (myositis and myopathy, mainly facio-scapulo-humeral muscular dystrophy (FSHD)) 2
• Other causes include central nervous system diseases, such as Parkinson's disease, dystonia, multisystem atrophy, or Alzheimer's disease 4
• Peripheral nervous system diseases, such as primary myopathy, secondary myopathy, motor neuron disease, myasthenia, or chronic inflammatory demyelinating polyneuropathy, can also cause camptocormia 4
• Rare causes include adverse reactions of drugs, disc herniation, arthritis, spinal trauma, paraneoplastic disorder, or psychiatric disease 5

Diagnosis of Camptocormia

• The diagnosis is based on clinical findings, imaging of the cerebrum or spine, needle electromyography, or muscle biopsy 4
• A broad diagnostic approach is necessary due to the heterogeneous etiologies of camptocormia 2
• The main diagnostic aim is to discover the etiology by looking for signs of the underlying disease in the neurological examination, EMG, muscle MRI and possibly biopsy 2

Treatment of Camptocormia

• There is no established treatment of camptocormia resulting from any etiology 2
• Treatment options are limited and frequently futile and rely on conservative measures, such as psychotherapy, physiotherapy, use of orthoses, drugs, injection of botulinum toxin, withdrawal of causative drugs, electroconvulsive therapy, or invasive measures, such as surgical correction or deep brain stimulation 4
• Recent studies have suggested the use of botulinum toxin may improve posture in some affected individuals 6
• In acute myositic camptocormia an escalation strategy with different immunosuppressive drugs is recommended 2
• In dystonic camptocormia, case reports have shown botulinum toxin and DBS of the globus pallidus internus (GPi-DBS) to be effective 2