Multiple Neck Operations in a Patient With Severe Motor Tics
Multiple Neck Operations in a Patient With Severe Motor Tics
Introduction In patients with Tourette's syndrome who have severe motor tics, involuntary neck movements can enhance degenerative changes in the cervical spine, occasionally causing myelopathy. There have been a limited number of reports on surgical treatment for cervical myelopathy caused by Tourette's syndrome, and a consensus for surgical treatment has not been fully established. To the best of our knowledge, this is the first report that describes a case of cervical myelopathy in a patient with Tourette's syndrome with severe motor tics who has undergone multiple surgeries of the cervical spine.
Case presentation A 44-year-old Asian man with severe motor tics due to Tourette's syndrome presented with cervical myelopathy. Previously, he had undergone an anterior discectomy and spinal fusion with ceramics at the C3-C4 and C5-C6 levels, but required further surgery because of displacement of the ceramics. After the second operation, he developed compression myelopathy at the sandwiched (C4-C5) disc level, and had to undergo a C4-C5 anterior discectomy and spinal fusion, which was unsuccessful.
As a salvage operation, we performed a C3-C7 decompression and spinal fusion from both the anterior and posterior approaches. By thorough postoperative external immobilization of his neck, our patient's spinal fusion was successful and his neurological improvements were maintained for more than 10 years.
Conclusions Patients with Tourette's syndrome with cervical myelopathy are at risk of having multiple neck operations to correct their symptoms. Postoperative immobilization and the correct selection of surgical procedure are quite important for successful spinal fusion and for avoiding complications at adjacent levels in these patients.
Tourette's syndrome is a complex, childhood-onset, neurobehavioral disorder characterized by chronic motor and phonic tics. In patients with Tourette's syndrome and severe motor tics, involuntary neck movements can enhance the development of cervical spondylosis and/or disc herniation, resulting in cervical myelopathy. Surgical treatment is indicated for patients with Tourette's syndrome who develop cervical myelopathy. However, to the best of our knowledge, only seven cases of surgical treatment have been reported: four cases of decompression surgery and three cases of decompression with spinal fusion (Table 1). In these patients, when postoperative management of their involuntary neck movements was inadequate, the surgical outcomes were not necessarily sufficient. Adler et al. reported the case of a patient in whom the fusion was broken after surgery, Krauss and Jankovic reported a patient with late neurological deterioration that occurred several years after surgery and Dobbs and Berger reported the case of a patient whose symptoms worsened just 10 weeks after surgery. The other four cases were not followed-up over the long term.
We report a case of cervical spondylotic myelopathy in a patient with severe motor tics because of Tourette's syndrome. Our patient had undergone three surgeries for myelopathy prior to visiting our clinic. We performed multisegment spinal decompression and fusion from both the anterior and posterior approaches for this patient. With postoperative external immobilization of his neck, our patient's spinal fusion was successful and his neurological improvements were maintained for more than 10 years.
Abstract and Introduction
Abstract
Introduction In patients with Tourette's syndrome who have severe motor tics, involuntary neck movements can enhance degenerative changes in the cervical spine, occasionally causing myelopathy. There have been a limited number of reports on surgical treatment for cervical myelopathy caused by Tourette's syndrome, and a consensus for surgical treatment has not been fully established. To the best of our knowledge, this is the first report that describes a case of cervical myelopathy in a patient with Tourette's syndrome with severe motor tics who has undergone multiple surgeries of the cervical spine.
Case presentation A 44-year-old Asian man with severe motor tics due to Tourette's syndrome presented with cervical myelopathy. Previously, he had undergone an anterior discectomy and spinal fusion with ceramics at the C3-C4 and C5-C6 levels, but required further surgery because of displacement of the ceramics. After the second operation, he developed compression myelopathy at the sandwiched (C4-C5) disc level, and had to undergo a C4-C5 anterior discectomy and spinal fusion, which was unsuccessful.
As a salvage operation, we performed a C3-C7 decompression and spinal fusion from both the anterior and posterior approaches. By thorough postoperative external immobilization of his neck, our patient's spinal fusion was successful and his neurological improvements were maintained for more than 10 years.
Conclusions Patients with Tourette's syndrome with cervical myelopathy are at risk of having multiple neck operations to correct their symptoms. Postoperative immobilization and the correct selection of surgical procedure are quite important for successful spinal fusion and for avoiding complications at adjacent levels in these patients.
Introduction
Tourette's syndrome is a complex, childhood-onset, neurobehavioral disorder characterized by chronic motor and phonic tics. In patients with Tourette's syndrome and severe motor tics, involuntary neck movements can enhance the development of cervical spondylosis and/or disc herniation, resulting in cervical myelopathy. Surgical treatment is indicated for patients with Tourette's syndrome who develop cervical myelopathy. However, to the best of our knowledge, only seven cases of surgical treatment have been reported: four cases of decompression surgery and three cases of decompression with spinal fusion (Table 1). In these patients, when postoperative management of their involuntary neck movements was inadequate, the surgical outcomes were not necessarily sufficient. Adler et al. reported the case of a patient in whom the fusion was broken after surgery, Krauss and Jankovic reported a patient with late neurological deterioration that occurred several years after surgery and Dobbs and Berger reported the case of a patient whose symptoms worsened just 10 weeks after surgery. The other four cases were not followed-up over the long term.
We report a case of cervical spondylotic myelopathy in a patient with severe motor tics because of Tourette's syndrome. Our patient had undergone three surgeries for myelopathy prior to visiting our clinic. We performed multisegment spinal decompression and fusion from both the anterior and posterior approaches for this patient. With postoperative external immobilization of his neck, our patient's spinal fusion was successful and his neurological improvements were maintained for more than 10 years.
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