Cervical Radiculopathy Caused by Vertebral Artery Loop Formation : A Case Report and Review of the Literature

Abstract

Vertebral artery loop formation causing encroachment on cervical neural foramen and canal is a rare cause of cervical radiculopathy. We report a case of 61-year-old woman with vertebral artery loop formation who presented with right shoulder pain radiating to her arm for 2 years. Plain radiograph and computed tomography scan revealed widening of the right intervertebral foramen at the C5-6 level. Magnetic resonance imaging and angiogram confirmed the vertebral artery loop formation compressing the right C6 nerve root. We had considered microdecompressive surgery, but the patient's symptoms resolved after conservative management. Clinician should keep in mind that vertebral artery loop formation is one of important causes of cervical radiculopathy. Vertebral artery should be visualized using magnetic resonance angiography in suspected case.

Medial Loop of V2 Segment of Vertebral Artery Causing Compression of Proximal Cervical Root

“…This was probably because the VA could not exert a strong pulsatory effect on the proximal root and there might be a remaining space for the root based three-dimensional constructions. In two other reports with cervical radiculopathy associated with the medial loop of the VA, the symptoms were treated with either conservative or surgical approaches4,11). In the present study, the cervical radiculopathy was resolved after conservative treatment.…”

“…One report related to anatomical variations of the VA stated that the incidence of a medial loop of the VA protruding into the proximal part of the intervertebral foramen was 0.8%3). Reports based on cadaveric and imaging studies only emphasized the importance of preoperative investigations and only two reports described spontaneous cervical radiculopathy4,11). However, none of the cases in the present study developed symptoms spontaneously.…”

Cervical Radiculopathy Caused by a Vertebral Artery Loop: Is a Focused Fluoroscopic‐Guided Cervical Epidural Steroid Injection a Possible Treatment Modality?

“…The pathogenesis of a tortuous VA is unclear. Narrowing of disc space with consecutive elongation of the VA, hemodynamic stress, and spondylotic changes or congenital idiopathies have been suggested as possible causes 11–15 . However, it is important to consider that not every VA loop is symptomatic.…”

“…Regarding treatment modalities, the literature on this topic is sparse due to the rarity of this entity. Most case reports, series, and reviews describe different microvascular decompression approaches as a valuable treatment modality after conservative treatment with medications and physical therapy 22,12 . The main goal of surgical treatment is the decompression of the neural structure with transposition of redundant VA loops, via either the anterolateral or posterolateral approach.…”

The diagnosis and management of a vertebral artery loop causing cervical radiculopathy

“…Vertebral artery loop formation is a rare cause of cervical radiculopathy which can also be attributed to congenital, cystic, vascular and neoplastic conditions [16]. However, differential diagnoses of vertebral artery loop formation due to radiographically widened neural exit foramen may include benign peripheral nerve sheath tumour, congenital absence or hypoplasia of the pedicle, dural ectasia (such as in Marfan syndrome, Ehlers Danlos or neurofibromatosis), intra-spinal neoplasm, meningocele or arachnoid cyst, or metastatic destruction of the pedicle [6].…”