Objective:

To demonstrate the efficacy of spinal orthosis in antecollis and PISA syndrome in Parkinson patients.

Background: Postural deformities in Parkinson disease (PD) including antecollis, PISA syndrome are disabling phenomena involving the extreme bending of neck and lateral trunk flexion. The early diagnosis and treatments are essential since the spine could still be reversible before turning to irreversible in the late stage. However, the treatment is still inconsistent due to poorly understood mechanisms. Some patients did not respond with neither adjusted oral medication nor injection. The design of spinal orthosis is challenging compared to idiopathic scoliosis since the deformity is not permanent during the day. The corrective pad or applied force should not aggravate the dystonia symptom or limit the movement abilities.

Method:

A 61 years old man known case PD for 8 years has developed antecollis and Pisa syndrome for 3 years. The symptom was aggravated during the “off”-period or after prolonged walking, which made him walk unstable and reduced walking speed. The head drop was not responded with Botulinum toxin injection. Therefore, we designed the Cervical Thoracic Orthosis (CTO) made from the low temperature thermoplastic material that can correct the deformity and maintain his posture in daily living without constrain the movement. The material is easy to adjust following the spinal curve. Walking VDO was recorded and the motion was measured from the 2D motion analysis software between with and without orthosis. The head drop was measured from the angle between the vertical line and common tangent of the occipital and back. The lateral deviation (Pisa angle) was measured by the angle between a line from the jugular notch to pubic symphysis and the line from pubic symphysis to the midpoint of the feet.

Results:

          Before wearing the CTO, during the “off”-period he has a head drop at 21 degrees(D), which was reduced to 12 D after wearing the CTO. The lateral deviation was reduced from 19 D to 5 D. At home, he observed less degree of head drop and lateral trunk bending during “on” and “off” time.

Conclusion:

This case illustrates the potential of the orthosis in improving the spinal curvature and head drop. The further study should be monitored in the long term and applied with a larger trial to prove this promising result in reducing or preventing the spinal curve progression.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/spinal-orthosis-in-antecollis-and-pisa-syndrome-in-parkinson/