Camptocormia is a potentially debilitating condition in the progression of Parkinson’s disease (PD). It is described as an abnormal forward flexion while standing that resolves when lying supine. Although the condition is relatively common, the underlying pathophysiology and optimal treatment strategy are unclear. In this study, the authors systematically reviewed the current surgical management strategies for camptocormia.
PubMed was queried for primary studies involving surgical intervention for camptocormia in PD patients. Studies were excluded if they described nonsurgical interventions, provided only descriptive data, or were case reports. Secondarily, data from studies describing deep brain stimulation (DBS) to the subthalamic nuclei were extracted for potential meta-analysis. Variables showing correlation to improvement in sagittal plane bending angle (i.e., the vertical angle caused by excessive kyphosis) were subjected to formal meta-analysis.
The query resulted in 9 studies detailing treatment of camptocormia: 1 study described repetitive trans-spinal magnetic stimulation (rTSMS), 7 studies described DBS, and 1 study described deformity surgery. Five studies were included for meta-analysis. The total number of patients was 66. The percentage of patients with over 50% decrease in sagittal plane imbalance with DBS was 36.4%. A duration of camptocormia of 2 years or less was predictive of better outcomes (OR 4.15).
Surgical options include transient, external spinal stimulation; DBS targeting the subthalamic nuclei; and spinal deformity surgery. Benefit from DBS stimulation was inconsistent. Spine surgery corrected spinal imbalance but was associated with a high complication rate.
Correspondence Andrew K. Chan: University of California, San Francisco, CA. firstname.lastname@example.org.
INCLUDE WHEN CITING Published online September 14, 2018; DOI: 10.3171/2018.4.JNS173032.
Disclosures Dr. Larson reports receipt of honoraria from Medtronic and support of non–study-related clinical or research effort from Voyager Therapeutics and serving as a consultant for Abbott. Dr. Mummaneni reports a consultant relationship with DePuy Spine, Globus, and Stryker; direct stock ownership in Spinicity/ISD; support of non–study-related clinical or research effort from NREF and ISSG; royalties from DePuy Spine, Thieme, and Springer; and honoraria from AO Spine.
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