Clinical Sciences/Health Conditions
David M. Crandell, MD
Assistant Professor
Spaulding Rehabilitation Hospital, Harvard Medical School Dept of PM&R
Needham, Massachusetts, United States
Kira M. Garry, MD
Resident
Spaulding Rehabilitation Hospital, Harvard Medical School Dept of PM&R
Charlestown, Massachusetts, United States
Kathleen Lefiles, BS
Medical student
University of Arizona Medical School
Tuscon, Arizona, United States
Camptocormia, or “bent-spine syndrome”, can be linked to a number of neuromuscular conditions. In some instances, it can be functional in nature and seen with other disabling conditions. We describe a 60-year-old woman who developed a rapidly progressive kyphoscoliosis deformity over six months, associated with failure to thrive and depression who was evaluated by many specialties including orthopedics, neurology and PM&R, without clear treatment options.
Case Description:
After an acute hospitalization for treatment of stress cardiomyopathy, the patient was admitted to an Inpatient Rehabilitation Facility and underwent interdisciplinary evaluations. She demonstrated a marked forward flexion of her thoracolumbar spine (estimated at over 45 degrees) and a moderate scoliotic curvature. This posture made walking extremely difficult, necessitating the use of a walker. She reported constant back pain, which she rated highly on a pain scale, and an inability to straighten her back. There was no significant muscle weakness noted in her limbs upon formal testing. A key clinical feature was the observation that her posture would completely normalize when lying supine. The patient was managed with an interdisciplinary approach involving education, addressing the underlying psychological stressors, and gradual physical and occupational therapy.
Discussions:
With two weeks of intensive therapy, her back pain lessened, her posture started to normalize, and she gradually regained the ability to walk upright using a rolling walker. This case illustrates a rare but important presentation of camptocormia with a psychogenic origin. The rapid progression, lack of muscle weakness or fixed deformity despite comprehensive workup, and the presence of psychological stressors strongly indicated a functional cause.
Conclusions:
Camptocormia, or “bent-spine syndrome”, can be a serious and progressive disabling condition. While neuromuscular disorders are the primary causes today, functional camptocormia still exists and requires a careful, multidisciplinary diagnostic approach to avoid misdiagnosis and allow for appropriate, effective team treatment.
