Botulinum Neurotoxin Treatment of Camptocormia- A Critical Review and Update

Camptocormia is a disabling postural disorder characterized by involuntary forward flexion of the thoracolumbar spine that resolves in the supine position. It is mostly associated with Parkinson's disease and parkinsonian syndromes, but may also occur in dystonia, paraspinal myopathies, and after exposure to some drugs. Available treatments, including postural aids, medication adjustment, and deep brain stimulation, are often only partly effective and may carry risk. Because overactivity of trunk flexor muscles is thought to contribute to camptocormia, botulinum neurotoxin (BoNT) has emerged as a potential treatment. This review critically evaluates the published literature on BoNT treatment of camptocormia. We searched Medline, Google Scholar, and Scopus for English-language publications published through April 1, 2026, identifying nine reports including three case series and six single case reports. No randomized placebo-controlled trials were found. Most studies used onabotulinumtoxinA, but injection targets, dosing, and outcome measures varied. Improvement in posture, reduced pain and functional benefits were described. The most consistent benefit was with bilateral injection of the rectus abdominis and external oblique muscles, whereas isolated psoas or iliopsoas injections were less effective. Overall, BoNT appears promising for the treatment of camptocormia; however, randomized, placebo-controlled trials are needed to confirm efficacy and establish optimal treatment protocols. The studies should be conducted with caution because long-term outcome data are limited and reported efficacy has been modest.