Postural Deformities and Surgical Interventions in Parkinson's Disease

Postural deformities such as camptocormia, Pisa syndrome and antecollis are disabling complications of Parkinson’s disease that arise from a complex interplay of musculoskeletal, sensory and neural factors. These axial misalignments contribute to pain, impaired balance, increased fall risk and reduced quality of life. Pathophysiological mechanisms include alterations in proprioceptive integration, vestibular dysfunction, focal muscle myopathy and central sensorimotor reorganisation. While dopaminergic therapy and rehabilitation may offer partial relief, severe or progressive deformities often necessitate surgical approaches. Spinal interventions encompass posterior fusion, corrective osteotomies and instrumentation, yet are associated with high rates of hardware failure, non-union and reoperation. Emerging neurosurgical modalities such as subthalamic deep brain stimulation have shown modest improvements in stooped posture, suggesting a role for basal ganglia modulation in axial alignment. Optimal management requires multidisciplinary assessment, careful evaluation of bone quality and surgical risk stratification, as well as postoperative rehabilitation to maintain correction and functional mobility.

Research from Nature Portfolio

Recent studies have elucidated the role of verticality misperception in the development of lateral trunk flexion in Parkinson’s disease. One seminal investigation demonstrated that errors in subjective visual vertical testing strongly predict the occurrence of lateral flexion, revealing that abnormal vestibular processing and asymmetric paraspinal muscle activation act as independent contributors to Pisa syndrome. This work also identified distinct subgroups of patients whose postural deviation aligns or misaligns with their perceived vertical, suggesting heterogeneous pathogenic mechanisms and underscoring the need for tailored therapeutic strategies.

Postural Deformities and Surgical Interventions in Parkinson's Disease publication trend

The graph below shows the total number of articles in postural deformities and surgical interventions in parkinson's disease across all publications each year (not limited to Nature Index journals).

Technical terms

Camptocormia: Severe abnormal anterior flexion of the trunk, typically exceeding 45°.

Pisa syndrome: Marked lateral bending of the trunk, often reversible in the supine position.

Antecollis: Excessive forward flexion of the neck.

Subjective visual vertical: A psychophysical measure of perceived gravitational verticality used to assess vestibular function.

Spinal instrumentation: Surgical implantation of rods, screws and cages to stabilise and correct spinal deformity.

Spino-pelvic realignment: Restoration of the optimal spatial relationship between the spine and pelvis in deformity surgery.

References

1. Camptocormia in Parkinson′s Disease. Parkinson's Disease (2010).
2. Myofibrillar disorganization characterizes myopathy of camptocormia in Parkinson’s disease. Acta Neuropathologica (2011).
3. Task Force Consensus on Nosology and Cut‐Off Values for Axial Postural Abnormalities in Parkinsonism. Movement Disorders Clinical Practice (2022).
4. Spinal Surgery in Patients with Parkinson’s Disease: Unsatisfactory Results, Failure and Disappointment. The Open Orthopaedics Journal (2014).
5. The Effect of Medication and Deep Brain Stimulation on Posture in Parkinson's Disease. Frontiers in Neurology (2019).
6. The fate of thoracolumbar surgeries in patients with Parkinson’s disease, and analysis of risk factors for revision surgeries. BMC Musculoskeletal Disorders (2019).
7. Pisa Syndrome in Parkinson’s Disease: Pathogenic Roles of Verticality Perception Deficits. Scientific Reports (2018).