The bent spine — camptocormia and the honest ceiling

Camptocormia by the Margraf definition is a marked thoracolumbar flexion that appears upright and resolves supine — which this man demonstrates exactly — and its management is unglamorous: positioning, a bracing trial, trunk-specific rehabilitation and a dopaminergic review, with the limits of each stated plainly. The botulinum-toxin literature is small and conflicting and the 2024 systematic review found it insufficient, so it is a movement-disorders discussion, not a first-line promise. What you do with it: build the positioning programme, trial the brace, grade the trunk work, put the lift or the board in the house, and train the wife’s mechanics as if her back were in the notes — because now it is.

• Back pain with leg symptoms or any step-change in the flexion — image before loading; fracture and stenosis live in this age group
• Skin redness over the thoracic apex or the seat — the flexed posture loads unusual surfaces
• The wife’s back pain worsening — the transfer plan has already failed once it hurts her

• H&Y V — maintenance is not giving upTier 4
• Three weeks after DBS — exercise in the “on” windowTier 3

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