title: Pisa syndrome in Parkinson's disease: a mobile or fixed deformity?
abstract: BACKGROUND
  Although Pisa syndrome and scoliosis are sometimes used interchangeably to describe a laterally flexed postural deviation in Parkinson's disease (PD), the imaging findings of Pisa syndrome in PD have not been previously studied in detail.
  
  
  METHODS
  Patients with PD and Pisa syndrome (lateral flexion >10° in the standing position) were examined clinically and underwent radiological assessment using standing radiograph and supine CT scan of the whole spine.
  
  
  RESULTS
  Fifteen patients were included in this observational study. All patients had scoliosis on standing radiographs, and 12 had scoliosis persisting in the supine position. Scoliotic curves improved by a mean of 44% when patients moved from standing to supine. Only a quarter of patients with structural scoliosis had evidence of bony fusion on the side of their lateral deviation rendering their deformity fixed.
  
  
  CONCLUSIONS
  Pisa syndrome describes a patient who lists to the side whereas scoliosis is defined by spinal curvature and rotation and may not be associated with lateral flexion. The finding of 'structural scoliosis' in Pisa syndrome should not preclude intervening to improve posture as most patients had little or no evidence of structural bony changes even when the deformity had been present for a number of years.
authors.affiliation: Reta Lila Weston Institute of Neurological Studies, UCL Institute of Neurology, , London, UK.
authors.forename: Karen M
authors.initials: KM
authors.lastname: Doherty
authors.forename: Indran
authors.initials: I
authors.lastname: Davagnanam
authors.forename: Sean
authors.initials: S
authors.lastname: Molloy
authors.forename: Laura
authors.initials: L
authors.lastname: Silveira-Moriyama
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lees
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D010300:Parkinson Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D011187:Posture; D011859:Radiography; D012600:Scoliosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology*; D013131:Spine / Q000000981:diagnostic imaging / Q000473:pathology*; D013577:Syndrome
keywords: PARKINSON'S DISEASE