Journal of Neural Transmission

, Volume 125, Issue 10, pp 1473–1480 | Cite as

Body height loss characterizes camptocormia in Parkinson’s disease

  • Urban M. Fietzek
  • Frauke E. Schroeteler
  • Lisa Hahn
  • Kerstin Ziegler
  • Andres O. Ceballos-Baumann
Neurology and Preclinical Neurological Studies - Original Article


Axial deformities such as camptocormia or Pisa syndrome in people with Parkinson’s disease (PwP) are poorly understood. The scarcity of information may result from the shortage of reliable and responsive evaluation instruments. We evaluated the body height loss (BHL) as a new measure for PwP with axial deformities. 50 PwP with axial deformity defined by an UPDRS item 28 value of at least 2 were included in this mono-center study. We measured body height while lying supine and after 1 min of standing, providing a percentage value of BHL, and compared this measure to other clinical variables. BHL depended on the Hoehn and Yahr clinical stage and correlated with clinical scales for function and mobility, but not with timely measures of the axial disorder such as age at diagnosis or duration of disease. ANOVA showed that only lumbar flexion explained the variability of BHL (F = 21.0, p < 0.0001), but not kyphosis (F = 0.4, p = 0.74) or lateroflexion (F = 0.6, p = 0.6). Re-test reliability of BHL was good with к = 0.76 (p < 0.0001). BHL resulted from the lumbar spine and the hip joint and not from the thoracic spine or lateroflexion. This observation conforms to the concept of upper-type and lower-type camptocormia with only the latter leading to a BHL. The assessment of the BHL is shown to be a well defined, easy to perform, and reliable measure for the clinical evaluation of lower-type camptocormia.


Parkinson’s disease Axial deformity Posture Camptocormia Body height 



We want to thank the Deutsche Stiftung Neurologie and the Deutsche Parkinson Vereinigung for generously supporting this research. We want to thank the involved patients for their collaboration.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

702_2018_1912_MOESM1_ESM.pdf (188 kb)
Supplementary material 1 (PDF 187 KB)
702_2018_1912_MOESM2_ESM.pdf (431 kb)
Supplementary material 2 (PDF 430 KB)
702_2018_1912_MOESM3_ESM.pdf (575 kb)
Supplementary material 3 (PDF 574 KB)


  1. Abdulhadi HM, Kerrigan DC (1996) Camptocormia: a biomechanical analysis. A case report. Am J Phys Med Rehabil Assoc Acad Physiatr 75:310–313CrossRefGoogle Scholar
  2. Abe K, Uchida Y, Notani M (2010) Camptocormia in Parkinson’s disease. Park Dis. CrossRefGoogle Scholar
  3. Ashour R, Jankovic J (2006) Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord 21:1856–1863CrossRefPubMedGoogle Scholar
  4. Azher SN, Jankovic J (2005) Camptocormia: pathogenesis, classification, and response to therapy. Neurology 65:355–359CrossRefPubMedGoogle Scholar
  5. Bettany-Saltikov J, Weiss H-R, Chockalingam N, Taranu R, Srinivas S, Hogg J, Whittaker V, Kalyan RV, Arnell T (2015) Surgical versus non-surgical interventions in people with adolescent idiopathic scoliosis. In: The Cochrane Collaboration (Ed.), Cochrane Database Syst. Rev. Wiley, ChichesterGoogle Scholar
  6. Bloch F, Houeto JL, Tezenas du Montcel S, Bonneville F, Etchepare F, Welter ML, Rivaud-Pechoux S, Hahn-Barma V, Maisonobe T, Behar C, Lazennec JY, Kurys E, Arnulf I, Bonnet AM, Agid Y (2006) Parkinson’s disease with camptocormia. J Neurol Neurosurg Psychiatry 77:1223–1228CrossRefPubMedPubMedCentralGoogle Scholar
  7. Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B, Ruzicka E, Goetz C, Stebbins G, Martinez-Martin P, Schrag A (2016) Movement Disorders Society Rating Scales Committee, Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: Critique and recommendations. Mov Disord 31:1342–1355CrossRefPubMedGoogle Scholar
  8. de Sèze M-P, Creuzé A, de Sèze M, Mazaux J-M (2008) An orthosis and physiotherapy programme for camptocormia: a prospective case study. J Rehabil Med 40:761–765CrossRefPubMedGoogle Scholar
  9. de Sèze MP, Guillaud E, Slugacz L, Cazalets JR (2015) An examination of camptocormia assessment by dynamic quantification of sagittal posture. J Rehabil Med 47:72–79PubMedGoogle Scholar
  10. Djaldetti R, Melamed E (2006) Camptocormia in Parkinson’s disease: new insights. J Neurol Neurosurg Psychiatry 77:1205CrossRefPubMedPubMedCentralGoogle Scholar
  11. Djaldetti R, Mosberg-Galili R, Sroka H, Merims D, Melamed E (1999) Camptocormia (bent spine) in patients with Parkinson’s disease—characterization and possible pathogenesis of an unusual phenomenon. Mov Disord 14:443–447CrossRefPubMedGoogle Scholar
  12. Doherty KM, van de Warrenburg BP, Peralta MC, Silveira-Moriyama L, Azulay J-P, Gershanik OS, Bloem BR (2011) Postural deformities in Parkinson’s disease. Lancet Neurol 10:538–549CrossRefPubMedGoogle Scholar
  13. Fasano A, Geroin C, Berardelli A, Bloem BR, Espay AJ, Hallett M, Lang AE, Tinazzi M (2018) Diagnostic criteria for camptocormia in Parkinson’s disease: a consensus-based proposal. Parkinsonism Relat Disord. CrossRefPubMedGoogle Scholar
  14. Forsyth AL, Paul SS, Allen NE, Sherrington C, Fung VSC, Canning CG (2017) Flexed truncal posture in parkinson disease: measurement reliability and relationship with physical and cognitive impairments, mobility, and balance. J Neurol Phys Ther 41:107–113CrossRefPubMedGoogle Scholar
  15. Furusawa Y, Mukai Y, Kobayashi Y, Sakamoto T, Murata M (2012) Role of the external oblique muscle in upper camptocormia for patients with Parkinson’s disease. Mov Disord 27:802–803CrossRefPubMedGoogle Scholar
  16. Gandor F, Basta D, Gruber D, Poewe W, Ebersbach G (2016) Subjective visual vertical in PD patients with lateral trunk flexion. Park Dis 2016:7489105. CrossRefGoogle Scholar
  17. Gdynia H-J, Sperfeld A-D, Unrath A, Ludolph AC, Sabolek M, Storch A, Kassubek J (2009) Histopathological analysis of skeletal muscle in patients with Parkinson’s disease and “dropped head’/’bent spine” syndrome. Parkinsonism Relat Disord 15:633–639CrossRefPubMedGoogle Scholar
  18. Gibb WR, Lees AJ (1988) A comparison of clinical and pathological features of young- and old-onset Parkinson’s disease. Neurology 38:1402–1406CrossRefPubMedGoogle Scholar
  19. Goetz CG, Tilley BC, Shaftman SR, Stebbins GT, Fahn S, Martinez-Martin P, Poewe W, Sampaio C, Stern MB, Dodel R, Dubois B, Holloway R, Jankovic J, Kulisevsky J, Lang AE, Lees A, Leurgans S, LeWitt PA, Nyenhuis D, Olanow CW, Rascol O, Schrag A, Teresi JA, van Hilten JJ, LaPelle N (2008) Movement disorder society-sponsored revision of the unified Parkinson’s Disease Rating Scale (MDS-UPDRS): scale presentation and clinimetric testing results. Mov Disord 23:2129–2170CrossRefPubMedGoogle Scholar
  20. Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression and mortality. Neurology 17:427–442CrossRefPubMedGoogle Scholar
  21. Inzelberg R, Hattori N, Nisipeanu P, Abo Mouch S, Blumen SC, Carasso RL, Mizuno Y (2003) Camptocormia, axial dystonia, and parkinsonism: phenotypic heterogeneity of a parkin mutation. Neurology 60:1393–1394CrossRefPubMedGoogle Scholar
  22. Lepoutre AC, Devos D, Blanchard-Dauphin A, Pardessus V, Maurage CA, Ferriby D, Hurtevent JF, Cotten A, Destee A, Defebvre L (2006) A specific clinical pattern of camptocormia in Parkinson’s disease. J Neurol Neurosurg Psychiatry 77:1229–1234CrossRefPubMedPubMedCentralGoogle Scholar
  23. Margraf NG, Wrede A, Rohr A, Schulz-Schaeffer WJ, Raethjen J, Eymess A, Volkmann J, Mehdorn MH, Jansen O, Deuschl G (2010) Camptocormia in idiopathic Parkinson’s disease: a focal myopathy of the paravertebral muscles. Mov Disord 25:542–551CrossRefPubMedGoogle Scholar
  24. Margraf NG, Granert O, Hampel J, Wrede A, Schulz-Schaeffer WJ, Deuschl G (2017) Clinical definition of camptocormia in Parkinson’s disease. Mov Disord Clin Pract 4:349–357CrossRefPubMedGoogle Scholar
  25. Margraf NG, Wolke R, Granert O, Berardelli A, Bloem BR, Djaldetti R, Espay AJ, Fasano A, Furusawa Y, Giladi N, Hallett M, Jankovic J, Murata M, Tinazzi M, Volkmann J, Berg D, Deuschl G (2018) Consensus for the measurement of the camptocormia angle in the standing patient. Parkinsonism Relat Disord 52:1–5CrossRefPubMedGoogle Scholar
  26. Nikfekr E, Kerr K, Attfield S, Playford DE (2002) Trunk movement in Parkinson’s disease during rising from seated position. Mov Disord 17:274–282CrossRefPubMedGoogle Scholar
  27. Podsiadlo D, Richardson S (1991) The timed “Up & Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148CrossRefPubMedPubMedCentralGoogle Scholar
  28. Song W, Guo X, Chen K, Huang R, Zhao B, Cao B, Chen Y, Shang HF (2014) Camptocormia in Chinese patients with Parkinson’s disease. J Neurol Sci 337:173–175CrossRefPubMedGoogle Scholar
  29. Srivanitchapoom P, Hallett M (2016) Camptocormia in Parkinson’s disease: definition, epidemiology, pathogenesis and treatment modalities. J Neurol Neurosurg Psychiatry 87:75–85PubMedGoogle Scholar
  30. St George RJ, Gurfinkel VS, Kraakevik J, Nutt JG, Horak FB (2018) Case studies in neuroscience: a dissociation of balance and posture demonstrated by camptocormia. J Neurophysiol 119:33–38CrossRefPubMedGoogle Scholar
  31. Tramonti C, Di Martino S, Unti E, Frosini D, Bonuccelli U, Rossi B, Ceravolo R, Chisari C (2017) Gait dynamics in pisa syndrome and camptocormia: the role of stride length and hip kinematics. Gait Posture 57:130–135CrossRefPubMedGoogle Scholar
  32. Wrede A, Margraf NG, Goebel HH, Deuschl G (2012) W.J. Schulz-Schaeffer, Myofibrillar disorganization characterizes myopathy of camptocormia in Parkinson’s disease. Acta Neuropathol (Berl) 123:419–432CrossRefGoogle Scholar
  33. Wright WG, Gurfinkel VS, King LA, Nutt JG, Cordo PJ, Horak FB (2010) Axial kinesthesia is impaired in Parkinson’s disease: effects of levodopa. Exp Neurol 225:202–209CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Neurology and Clinical Neurophysiology, Centre for Parkinson’s Disease and Movement DisordersSchön Klinik München SchwabingMunichGermany
  2. 2.Department of Neurology, Klinikum Rechts der IsarTechnische Universität MünchenMunichGermany

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