Brief Answer:
Isolating muscles that are dysfunctional very challenging

Detailed Answer:
Good afternoon.

I hope the response that I provided for you several days ago was helpful to you. I now see that you are looking for what appears to be more specific information on which muscles are involved in this condition and in what condition they are functioning at (e.g. spastic, dystonic, etc.) that causes the bent over position. Your question is really the "million dollar" one that everyone asks, however, there is no easy way to tell from the presentation of your case without performing a full blown neurological examination that would attempt at testing (both confrontationally as well as potentially with electrical stimulation) each muscle responsible for EXTENDING the vertebral column.

In other words, there is not just one single mechanism or conglomerate of muscles that perform DYSFUNCTIONALLY to cause the condition. We are not even agreed upon as to where this problem originates (BRAIN, SPINAL CORD, PERIPHERAL NERVE, MUSCLE) within the nervous system or musculoskeletal system. We are only agreed upon the final results which is the BENT OVER POSTURE that occurs in patients who are ambulatory vs. the relaxed posture they can assume of the spine when they lay supine.

Essentially, there are 2 major theories as to how CAMPTOCORMIA plays out. One is that the causes are CENTRAL in nature (i.e. originating in the brain itself) and involve patients who already have neurodegenerative problems such as PARKINSON'S, MSA, ALZHEIMER'S resulting in motor areas altering signal output that ultimately manifests as DYSFUNCTION in the spinal column's ability to extend.

The 2nd major category of diseases that are believed to cause this condition typically result in dysfunction to the PERIPHERAL NERVES that connect to the extensor muscles themselves. And so things such as MYASTHENIA GRAVIS, DRUG INDUCED POLYNEUROPATHIES, DISC HERNIATIONS, ARTHRITIS, SPINAL COLUMN TRAUMA, COMPRESSIVE TUMORS, etc. are the forerunners of this secondary postural dilemma.

As you've mentioned there are a number of individual as well as GROUPS of muscles responsible for extending the vertebral column. Any one or any group of these muscles can be the culprit and the only way to know is by doing a full neurological examination and then, as necessary utilizing electrical studies such as EMG to test specific muscles, or even resorting to muscle biopsies in order to determine where the problem lies.

However, from a clinical perspective, even if the primary disease can be identified, the best outcomes that can be hoped for involve optimal treatment of the primary problem. In other words, in your case if your PARKINSON'S DISEASE were able to be fully managed to the point where regional dystonic manifestations (resulting in the bent spine) could be eliminated then, theoretically, that problem would greatly diminish or improve. Sometimes, if the exact muscle or group of muscles can be identified then, things such as BOTULINUM TOXIN can be directly delivered under EMG guidance by an experienced operator and this may lessen the intensity of the problem. Another way to manage Parkinson's disease that could result in improvement in the bent spine could be using DEEP BRAIN STIMULATION or even a LEVODOPA PUMP implanted in the gut (assuming the patient already exhibits a decent response to levodopa therapy in the first place.

If the problem is identified as being metabolic, drug induced, or due to hormonal imbalances then, obviously management of those causes would theoretically yield improved outcomes but again, it really depends on the severity and length of time that has passed with this problem as to just how successful one can be at "releasing the muscles" from their abnormal tone and activity allowing the spinal column to straighten.

In some cases, aggressive ELECTROCONVULSIVE THERAPY applied to the brain may "shock" the brain circuits out of their DISARRAY and back into a normal pathway of functioning....it's almost like REBOOTING the system....but there are only isolated cases described where this form of therapy has actually worked.

In my practice if patients are truly interested in discovering the bottomline as to what is causing their bent spine condition I am all for doing the full magilla to figure it out...so long as the patient also agrees that at the end of the day, the condition's outcome may not improve significantly from what it was before the full array of tests (some which may be invasive) occurred.

As a point of interest, I notice that you are sending us your query in from Elyria, OH. I am the Chief Neurologist at Parma Neurologist which is about 45 minutes to your East. If you are interested in a full workup as I've described to try and find the exact muscles that are behaving badly to see what the chance of correction may be I'd be happy to take you through that workup. You can reach our office at 440.842.3816 to schedule an appointment for a 2nd opinion.

Otherwise, if I've provided useful or helpful information to your questions and you have no further inquiries or comments at this time then, could you do me the utmost of favors in closing the query along with a few positive words of feedback and maybe even a 5-star rating if you feel it is deserving? I am definitely interested in getting updated information on how things are going in the next few days or weeks if you'd care to drop me a line at www.bit.ly/drdariushsaghafi

You can always reach me at the above address for this and other questions. I wish you the best with everything and hope this conversation has helped you give you a little more direction as to what you may wish to do as well as things you can discuss with your doctors.

This query required 60 minutes of professional time to research, assimilate, and respond in complete form.

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