title: Multiple neck operations in a patient with severe motor tics because of Tourette's syndrome: a case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
authors: Spine Section, Department of Orthopaedic Surgery, Chiba University Graduate School of Medicine, Chiba, Japan. tommiya3@yahoo.co.jp.
authors: Tomohiro
authors: T
authors: Miyashita
authors: Masashi
authors: M
authors: Yamazaki
authors: Akihiko
authors: A
authors: Okawa
authors: Minori
authors: M
authors: Yoneda
authors: Atsuomi
authors: A
authors: Aiba
authors: Masao
authors: M
authors: Koda
authors: Kazuhisa
authors: K
authors: Takahashi