Camptocormia in Parkinson's disease: state of the art and future directions.

Abstract

Camptocormia is a frequent axial postural deformity in Parkinson's disease (PD) that is prevalent in up to 18% in the PD population. Camptocormic PD patients have a lower quality of life and higher risks of falls, back pain and spondylarthrosis. Camptocormia is probably induced by brain changes caused by PD. Despite the myopathic changes in camptocormic PD patients' spine muscles and camptocormia's clinical similarity with dystonic postures, its pathophysiology seems to be different from myopathy and dystonia. The exact pathogenesis is however unclear. There is no consensus for treatment of PD-related camptocormia, although some nonpharmacological (e.g., backpack weight, back extensors and physiotherapy), pharmacological (e.g., levodopa, istradefylline and botulinum toxin) and surgical approaches (surgical corrections and deep brain stimulation) were elaborated upon with variable effects. There are still many gaps in data regarding clinical predictors, pathophysiology, the treatment and prevention of camptocormia. Multicenter studies (particularly on nonpharmacological therapy, on preventing strategies, and on favorizing factors) are needed. We identified an unexpectedly limited number of publications on camptocormia in PD. As of August 2025, the search strategy with MeSH terms related to camptocormia, on PubMed returned only 220 results. After screening, only 138 of the titles and abstracts were relevant to the topics. Of all these publications, only 27 (19.6%) were reviews, and more than half of which (15 reviews) focused on some characteristics of camptocormia (e.g., surgical treatment, deep brain stimulation, and prevalence or etiology) but did not elucidate on all its complex aspects. The present narrative review aims to describe different aspects of camptocormia ranging from its prevalence to the pathophysiology and treatment possibilities and provide a comprehensive image of this disorder.