Surgical management of tic-induced myelopathy and the importance of perioperative tic control: illustrative cases

BACKGROUND Degenerative cervical myelopathy (DCM) is the most common cause of adult spinal cord dysfunction. Tourette syndrome (TS) represents a rare cause of DCM that is incompletely characterized in the literature. Patients with TS might develop repetitive involuntary cervical movements that can accelerate spondylotic changes. Therefore, patients with myelopathy secondary to TS or other tic disorders might exhibit DCM symptoms at younger ages. The present study examines the surgical management of DCM secondary to TS in the literature and describes the outcomes of 3 patients who were treated for DCM secondary to TS. OBSERVATIONS In these 3 described cases, fractures led to DCM in 2 patients, while cervical spondylosis led to DCM in 1 patient, all associated with TS. Treating motor tics with medications or deep brain stimulation (DBS) provided effective tic management. All 3 patients experienced improvements in their neurological symptoms following surgery, consistent with other reports in the literature. LESSONS When treating patients with cervical myelopathy secondary to TS, the authors recommend prioritizing motor tic management prior to considering secondary interventions such as surgery. According to the authors, treating motor tics with medications or DBS provides effective tic management. This approach allows for an uncomplicated postoperative course and satisfactory relief of cervical myelopathy.