Camptocormia in Parkinson disease: an epidemiological and clinical study

Tiple, Dorina; Fabbrini, Giovanni; Colosimo, Carlo; Ottaviani, Donatella; Camerota, Filippo; Defazio, Giovanni; Berardelli, Alfredo

doi:10.1136/jnnp.2008.150011

Cited by 146 publications

(128 citation statements)

References 22 publications

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“…Camptocormia is an abnormal posture with marked flexion of the thoracolumbar spine, and it increases with time and fatigue during the day and during walking; it is a progressive postural insufficiency that abates in recumbent position, sitting or volitionally when the PD patient leans against a wall. There are usually no radiographic abnormalities or structural changes referring to that kind of neuromuscular dysfunction [1,12,24,32,39]. Camptocormia in PD patients was observed with an incidence of 7% dependant on the clinical severity of the PD.…”

Section: Discussionmentioning

confidence: 99%

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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Only a few reports exist concerning biomechanical challenges spine surgeons face when treating Parkinson's disease (PD) patients with spinal deformity. We recognized patients suffering from spinal deformity aggravated by the burden of PD to stress the principles of sagittal balance in surgical treatment. Treatment of sagittal imbalance in PD is difficult due to brittle bone and (the neuromuscular disorder) with postural dysfunction. We performed a retrospective review of 23 PD patients treated surgically for spinal disorders. Mean ASA score was 2.3 (2-3). Outcome analysis included review of medical records focusing on failure characteristics, complications, and radiographic analysis of balance parameters to characterize special risk factors or precautions to be considered in PD patients. The sample included 15 female and 8 male PD patients with mean age of 66.3 years (57-76) at index surgery and 67.9 years (59-76) at follow-up. 10 patients (43.5%) presented with the sequels of failed previous surgery. 18 patients (78.3%) underwent multilevel fusion (C3 level) with 16 patients (69.6%) having fusion to S1, S2 or the Ilium. At a mean follow-up of 14.5 months (1-59) we noted medical complications in 7 patients (30.4%) and surgical complications in 12 patients (52.2%). C7-sagittal center vertical line was 12.2 cm (8-57) preoperatively, 6.9 cm postoperatively, and 7.6 cm at follow-up. Detailed analysis of radiographs, sagittal spinal, and spino-pelvic balance, stressed a positive C7 off-set of 10 cm on average in 25% of patients at follow-up requiring revision surgery in 4 of them. Statistical analysis revealed that patients with a postoperative or follow-up sagittal imbalance (C7-SVL [10 cm) had a significantly increased rate of revision done or scheduled (p = 0.03). Patients with revision surgery as index procedure also were found more likely to suffer postoperative or final sagittal imbalance (C7-SPL, 10 cm; p = 0.008). At all, 33% of patients had any early or late revision performed. Nevertheless, 78% of patients were satisfied or very satisfied with their clinical outcome, while 22% were either not satisfied or uncertain regarding their outcome. The surgical history of PD patients treated for spinal disorders and the reasons necessitating redo surgery for recalcitrant global sagittal imbalance in our sample stressed the mainstays of spinal surgery in Parkinson's: If spinal surgery is indicated, the reconstruction of spinopelvic balance with focus on lumbar lordosis and global sagittal alignment is required.

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Section: Discussionmentioning

confidence: 99%

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

et al. 2010

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“…In a single-center epidemiological study on 275 consecutive outpatients with Parkinson’s disease, the prevalence of camptocormia was 6.9% [15]. The occurrence of camptocormia in this study was related to the severity of Parkinson’s disease [15]. …”

Section: Frequencymentioning

confidence: 99%

Presentation, Etiology, Diagnosis, and Management of Camptocormia

Finsterer

Strobl

2010

Eur Neurol

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Camptocormia (bent spine syndrome, cyphose hystérique) is an abnormality characterized by severe forward flexion of the thoracolumbar spine which typically increases during walking or standing and completely disappears in supine position. Camptocormia can be due to central nervous system diseases, such as Parkinson’s disease, dystonia, multisystem atrophy, or Alzheimer’s disease, due to peripheral nervous system diseases, such as primary myopathy, secondary myopathy, motor neuron disease, myasthenia, or chronic inflammatory demyelinating polyneuropathy, due to side effects of drug treatment, due to disc herniation, arthritis or spinal trauma, or due to paraneoplasia. Only rarely may camptocormia be attributable to psychiatric disease. The diagnosis is based on clinical findings, imaging of the cerebrum or spine, needle electromyography, or muscle biopsy. 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. The outcome is generally fair. Some patients profit from therapy whereas others do not respond to treatment and become progressively immobile.

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“…The reported prevalence varies widely. Tiple et al [15] revealed a prevalence of 6.9% in their outpatients (19/275). In contrast, Lepoutre et al [16] gave a hypothetic prevalence of 3% (23/700), but there are no prospective epidemiological studies as yet.…”

Section: Introductionmentioning

confidence: 99%

Camptocormia in Parkinson’s Disease: A Review of the Literature

Ponfick¹,

Gdynia²,

Ludolph³

et al. 2011

Neurodegener Dis

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Camptocormia (CC) is defined as a trunkal flexion which worsens while standing, sitting and walking and disappears in the supine position. CC is a well-known clinical phenomenon in patients with generalized neuromuscular disorders like polymyositis, myasthenia gravis or motor neuron diseases, and it is also described in the context of movement disorders like Parkinson’s disease (PD) or multiple system atrophy. In association with PD, CC seems to be a rare symptom which occurs preferentially in late stages of the disease. Currently, there are 3 main hypotheses on the pathogenesis of CC in PD, i.e. a focal myopathy of the trunk muscles, axial dystonia and a drug-induced etiology. This review gives a synopsis and critical acclaim of these 3 etiologies and refers to the current study data and possible treatment strategies.

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Camptocormia in Parkinson disease: an epidemiological and clinical study

Abstract: Camptocormia, a relatively common sign in PD seems to be related to the clinical severity of PD.

Cited by 146 publications

References 22 publications

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

Spinal surgery in patients with Parkinson’s disease: experiences with the challenges posed by sagittal imbalance and the Parkinson’s spine

Presentation, Etiology, Diagnosis, and Management of Camptocormia

Camptocormia in Parkinson’s Disease: A Review of the Literature

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