Camptocormia in the differential diagnosis of hyperkyphosis and ankylosing spondylitis

History and admission findings: An 83-year-old patient with Parkinson's disease was referred because of pain in the thoracolumbar spine, increasing kyphosis and gait disturbance. Clinically, the main anomaly was a marked hyperkyphosis of the spine during standing and sitting which regressed while recumbent. Investigations: Radiologically, spondylosis, osteochondrosis, and facet joint arthrosis demonstrated marked degeneration of the spine (diffuse skeletal hyperostosis, DISH). But the postural disorder could not adequately be explained by these pathological changes. The sacroiliac joints were age-appropriate, syndesmophytes or ankylosis typically of AS were not detectable. Diagnosis, treatment and course: A diagnosis of camptocormia in connection with the known Parkinson's disease was made together with the neurologist. Intensive physio- and balneotherapy, the administration of non-steroidal anti-inflammatory drugs (NSAIDs) and an intensification of the Parkinson medication led to a slight improvement of gait disturbance and pain, but not of the tendency to hyperkyphosis. Conclusion: In the differential diagnosis of postural disorders in spinal diseases, especially in case of hyperkyphosis, camptocormia is of importance as a rare manifestation of different diseases, such as Parkinson's disease. The treatment of camptocormia is difficult and usually not satisfactory.