Camptocormia in Parkinson’s Disease: Systematic Review of Management Using Spine Surgery

Introduction: Postural instability or deformity manifests in a variety of ways for a Parkinson's disease (PD) patient, including the classic stooped posture, as well as antecollis, pisa syndrome, degenerative scoliosis, and a debilitating forward flexion of the trunk termed camptocormia. Camptocormia was first described in the midst of World War 1, where young soldiers were found to have a non-fixed forward-bent trunk attributed to the stress of battle. As camptocormia encompasses a broad range of etiologies, various treatment modalities exist without any particular consensus for their use. In this study, the authors systematically reviewed the literature regarding the use of spine surgery for the treatment of camptocormia in PD patients.

Methods: PubMed was queried for studies involving spine surgery as treatment of PD-associated camptocormia. Studies that described nonsurgical management, deep brain stimulation (DBS), repetitive trans-spinal magnetic stimulation (rTSMS), or were descriptive in nature were excluded.

Results: The screening process resulted in 5 studies that reported on the use of spine surgery in PD-associated camptocormia. The total number of patients was 19, 12 of which experienced hardware failure warranting revision surgery (63.1%). Clinical and radiologic improvement was inconsistent. Patient outcomes were ultimately satisfactory, only after high reoperation and complication rates.

Conclusion : Evidence for the feasibility of spine surgery as management for PD-associated camptocormia is lacking in the literature. In this particular patient population, these procedures carry a high risk of complications and subsequent revision operations, which may negatively affect long-term quality of life. In the absence of or resistance to conservative management, DBS, or rTSMS, spine surgery may be the only option for some patients. Continued investigation via longitudinal and large-scale studies is crucial in order to provide definitive recommendations and treatment algorithms for providers to adhere to.