Camptocormia

Alexandre-Achille Souques was one of the first major researchers of camptocormia and created the definition and name used for the condition to this day.

Camptocormia comes from two Greek words, meaning "to bend" (κάμπτω, kamptō) and "trunk" (κόρμος, kormos), and was coined by Alexandre-Achille Souques and B. Rosanoff-Saloff. These two men also created the definition of the disease that is widely accepted today.[2]

When the disorder was first clinically studied around the time of First World War, it was believed to be a psychogenic conversion disorder that resulted from the severe trauma of war. Souques and others treated patients with psychological therapy and early versions of electrotherapy. Samuel A. Sandler used a similar approach to treat soldiers during the Second World War.[2] The view of BSS as a conversion disorder led to a lack of awareness about the conditions and few diagnoses by physicians.

As time progressed and advances were made in knowledge of neuroscience and physiology, biological mechanisms behind the irregular bending were identified. The current medically preferred term for the condition is bent spine syndrome, because of the psychological origin associated with camptocormia.[2]

The primary symptom of camptocormia is abnormal forward bending of the torso. This bending becomes worse while walking but does not appear when the affected individual is lying down in a horizontal position. This alleviation of the condition indicates that it is a manifestation of another disease or ailment and is not due to a spine that is actually bent.[2] This is somewhat ironic, since the medically accepted name for the condition is bent spine syndrome.

In an affected individual, the abnormal bending consists of an anterior flexion greater than 45 degrees.[3] Because of this bending and the physical limitations caused by the conditions associated with the disease, it is usually impossible for an affected person to achieve a fully erect position. In addition, patients with camptocormia often experience low back pain as a result of the condition. BSS often appears in individuals with Parkinson's disease, muscular dystrophies, endocrine disorders, inflammatory conditions (myositis), or mitochondrial myopathies.[1] As previously mentioned, the disease is more common in older individuals.

When initially identified, camptocormia was classified as a psychogenic disease. Although the condition is sometimes a psychogenic manifestation, camptocormia typically originates from either muscular or neurological diseases. However, due to the wide variety of pathologies resulting in camptocormia, there is no singular cause that is most influential for the condition.

In order to qualify a patient's condition as BSS, the bending angle must be greater than 45 degrees. While the presence of the condition is very easy to note, the cause of the condition is much more difficult to discern. Conditions not considered to be BSS include vertebral fractures, previously existing conditions, and ankylosing spondylitis. Lower-back CT scans and MRIs can typically be used to visualize the cause of the disease.[4] Further identification of the cause can be done by histochemical or cellular analysis of muscle biopsy.

Spinal-muscle biopsy showing intense endomysial deposit of fibrosis (green) and fatty infiltration. Also observable is irregular distribution of involuted muscle fibers. (Trichrome, original magnification ×9100)[2]

Camptocormia is becoming progressively found in patients with Parkinson's disease.[3] The diagnosis of Parkinson's-associated camptocormia includes the use of imaging of the brain and the spinal cord, along with electromyography or muscle biopsies.

Muscle biopsies are also a useful tool to diagnose camptocormia. Muscle biopsies found to have variable muscle fiber sizes and even endomysial fibrosis may be markers of bent spine syndrome. In addition, disorganized internal architecture and little necrosis or regeneration is a marker of camptocormia.

Patients with camptocormia present with reduced strength and stooped posture when standing due to weakened paraspinous muscles (muscles parallel to the spine). Clinically, limb muscles show fatigue with repetitive movements.[4] Paraspinous muscles undergo fat infiltration. Electromyography may be used as well in diagnosis. On average, the paraspinous muscles of affected individuals were found to be 75% myopathic, while limb muscles were 50% percent myopathic.[4] Creatine kinase activity levels in skeletal muscle are a diagnostic indicator that can be identifiable through blood tests.

This condition can lead to excess pressure on the spine, causing pain and discomfort.[4] If the spine is bent too far, a patient may have difficulties breathing because of the pressure of the spine pressed against the lungs. Camptocormia may also lead to muscle weakness in the upper back and to arthritis and other bone-degeneration diseases.[4] Because of loss of bone strength, injury to the spine and slipped discs become increasingly significant. Camptocormia can lead to infection, tumors, and diseases of the endocrine system and connective tissues. The success of the treatment method is largely dependent on the patient, but response to therapeutic methods is generally low.

Typical deep brain stimulation setup

Clinical studies have revealed that camptocormia may be hereditary; however, the inheritance mechanism remains unclear.[2] Current areas of research include molecular and genetic studies aimed at elucidating a possible inheritance model along with molecular pathological mechanisms and proteins responsible for BSS. This research will help will facilitate improvement in the classification, diagnosis, and treatment of the condition. In addition, new technologies and animal models of postural abnormalities are being developed to understand camptocormia and design more effective treatment methods.[4]