Case 244. (Roussy and Lhermitte, 1917.)

An infantryman was buried after shell explosion August 25, 1914, but he sustained no wound or bone injury. There was, however, a large ecchymosis of the lumbar region, and he had felt violent lumbar pains. The trunk was carried flexed, symmetrically bent over and quite incapable of being straightened completely. A plaster corset was applied March 16 by Souques. Three months of this was followed by a complete straightening, which lasted after the corset was removed. The patient was discharged well.

As to these cases of camptocormia, some authors regard them as due to anatomical changes in the vertebral column itself, or in the ligaments and muscles, and accordingly regard the condition as a form of spondylitis, syndesmitis, or psoitis. This view is held by Sicard, who bases the idea upon the local pains and the results of cerebrospinal fluid examination. According to Roussy and Lhermitte, hyperalbuminosis of the fluid is extremely rare, and one case of their own with hyperalbuminosis was nevertheless cured with great rapidity. Roussy and Lhermitte even inquire whether the fluid albumin may not be due in some way to an interference with venous and lymphatic circulation.

In some cases, this condition may be at first a response to pain, a pseudospondylitis dolorosa, such as may be sometimes observed in hospitals near the front. Later, however, the suffering in camptocormia is due more to the abnormal position of the trunk, with strain upon vertebral ligaments, than to the persistence of any original pain. Moreover, these patients recover almost immediately from their pains when the contraction is relieved.

In differential diagnosis, one has to consider, according to Roussy and Lhermitte, Pott’s disease, traumatic spondylitis, as well as Bechterew’s vertebral ankylosis, Pierre Marie’s rhizomelic spondylosis, Kocher’s intervertebral disc contusions, and Schuster’s myogenic ankylosis of the vertebral column; but in Pott’s disease, the fixed pain points, rigidity of column, fluid examination, and signs of myelitis, should suffice for the differential diagnosis. Traumatic spondylitis follows the contusion after months and after a phase of neuralgia. Ankyloses do not so much concern the trunk as the vertebral column itself; disc contusion produces disorders in standing and gait as well as pains and edema. Schuster’s disease shows paresis, hyper reflexia, and amyotrophy not shown in camptocormia.