Deep brain stimulation as a treatment for Parkinson's disease related camptocormia

In this systematic review, we aimed to profile the various reported interventions for camptocormia in Parkinson's disease (PD) and give an overview of the benefits of deep brain stimulation (DBS). Currently, there is no consensus in the literature regarding this. PD manifests in several ways and camptocormia is one of the commonly encountered problems for both spine and functional neurosurgeons. It is a significant forward flexion of the thoracolumbar spine which resolves in the recumbent position. DBS was introduced in 2002 in the USA, and since then its efficacy and applications have tremendously increased. We reviewed the PubMed and Medical Subject Headings database using the phrases "Parkinson's disease" or "Parkinson" in combination with "spinal deformity" or "camptocormia" or "bent spine syndrome" and "deep brain stimulation". Our review was limited to English language literature and we excluded camptocormia of non-PD origin. Our search yielded 361 articles with 131 patients in the pooled data. The majority (59%) of patients were women and the age range was 48-76 years. While half the patients on levodopa (n=42) saw no improvement of their camptocormia, 71% of the lidocaine group (n=27) and 68% of the DBS group (n=32) showed significant improvement. For mean flexion angle, the spinal surgery and DBS group demonstrated profound improvement in the bending angle, 89.9% and 78.2%, respectively. However, major complications following spinal surgery were noted. Although the results are from a small group of patients, DBS has achieved sustained improvement in camptocormia with low postoperative morbidity, and appears to be a promising treatment option. A larger, long term study is necessary to establish comprehensive outcome data.