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

Wood, Laurence; Czyż, Marcin; Forster, Stephen; Boszczyk, Bronek M.

doi:10.1007/s00586-017-5123-6

Cited by 8 publications

(9 citation statements)

References 23 publications

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“…Attempted conservative therapies included anti-inflammatories, epidural steroid injections, suprascapular nerve block, acupuncture, trigger point injections, and physical therapy. 2 , 4 , 7 , 8 , 15 , 17 , 18 , 20 Three patients (15.0%) had undergone previous surgeries without resolution of symptoms. These surgeries included anterior cervical discectomy and fusion, multiple shoulder surgeries, and posterior cervical foraminotomy.…”

Section: Discussionmentioning

confidence: 99%

Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case

Semonche,

Rinaldo,

Lee

et al. 2024

Journal of Neurosurgery: Case Lessons

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BACKGROUND Vertebral artery loops are a rare cause of cervical radiculopathy. Surgical options for nerve root decompression include an anterior or posterior approach, with or without additional microvascular decompression. OBSERVATIONS The authors describe a case of a 49-year-old man with a long-standing history of left-sided neck pain and migraines, who was found to have a vertebral artery loop in the left C3–4 neural foramen compressing the left C4 nerve root. The patient underwent a posterior cervical decompression with instrumented fusion and macrovascular decompression of the left C4 nerve root via Teflon felt insertion. In a literature review, we identified 20 similar cases that had also been managed surgically. LESSONS Although the anterior approach is more frequently described in the literature, a posterior approach for nerve compression by a vertebral artery loop is also a safe and effective treatment. The authors report the third case of this surgical approach with a good outcome.

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Section: Discussionmentioning

confidence: 99%

Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case

Semonche,

Rinaldo,

Lee

et al. 2024

Journal of Neurosurgery: Case Lessons

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“…For patients with cervical MR examinations, if there is an expansion of the vertebral foramen, VALF should be suspected and MRA should be performed [3]. It has been reported in the literature that conservative methods rarely succeed in treatment of this condition [8]. In addition, surgical approaches such as microvascular decompression and foraminotomy may be treatment options [2].…”

Section: Discussionmentioning

confidence: 99%

Tortuous vertebral artery triggering vertebral foramen expansion and radiculopathy in a 19-year-old patient: a case report

2020

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Background Arterial tortuosity is a widespread condition commonly occurring in cerebral arteries and often associated with the elderly. Moderate arterial tortuosity is often not symptomatic, but if there is severe tortuosity, various symptoms may occur, depending on the localization. In the literature, many factors have been reported as causing tortuosity in the vertebral arteries. In this case report, considering the age of our patient, we propose that, in addition to these previously reported reasons, congenital factors may also contribute to this situation. Case presentation We present a case of a 19-year-old Turkish patient with a tortuous vertebral artery causing pain and tingling in the right shoulder and neck. Magnetic resonance imaging revealed vertebral foramen enlargement thought to be secondary to a loop formation in the vertebral artery. The diagnosis was confirmed by magnetic resonance angiography. Conclusions There are many causes of cervical radiculopathy. Arterial tortuosity, a rare cause of radiculopathy, should be considered as a differential diagnosis. Consideration of the existence of this variation is of great importance in preventing possible dangerous complications during surgery.

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“…Oga et al [6] had classified the tortuosity in type 1 (straight), type 2 (mild tortuous), type 3 (loop formation) and type 4 (loop migration). VA tortuosity can be congenital or acquired, but the exact pathogenesis remains unclear [2,[6][7][8]. Some authors have speculated that haemodynamic stress due to arterial hypertension and atherosclerosis is the main cause, while others have associated it with degenerative changes [6,9,10].…”

Section: Vertebral Artery Anatomy and Variabilitymentioning

confidence: 99%

“…A majority of recent studies have utilized an anterolateral approach to mobilize the VA loop [1,7,8,[11][12][13][14][15][16]. The anterolateral approach allows a direct view and mobilization of the VA enclosed within the transverse processes [17,18].…”

Section: Anterolateral MV Decompression By Loop Mobilization and Separation From Nerve Rootmentioning

confidence: 99%

“…Various authors have used additional strategies to detether and keep the mobilized VA away from the compressed nerve root, such as cushioning with soft polymer sponges made of Teflon [1,7,11,13,14]. Wood et al [7] have utilized Dacron plugs, due to Teflon-associated granuloma formation, which was documented after the treatment of trigeminal neuralgia [20].…”

Section: Decompression By Neurovascular Separation With Surgical Plugsmentioning

confidence: 99%

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Anterior artery release, distraction and fusion (ARDF) for radiculopathy caused by a vertebral artery loop

2021

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Background Anomalous vertebral artery (VA) with loop formation is a rare cause of cervical nerve root compression. Various techniques with anterior and posterior approaches have been described for surgical treatment once conservative treatments fail. We herein present a case treated with the new technique of anterior release, distraction and fusion (ARDF) and further provide an updated review of surgically managed VA loops in the subaxial spine. Case description A 76-year-old female complained of a 6-year history of pulsating, shooting pain in her right arm to the thumb. After obtaining repeated MRI, the VA loop compressing the right-sided C6-nerve root was detected. A neurovascular decompression through ARDF which led to an indirect loop straightening was performed. The patient immediately improved after surgery and remained pain-free 1 year postoperative. Conclusion Neural irritation due to VA loop formation is a rare cause of cervical radiculopathy. While various surgical strategies have been described, we believe that anterior and anterolateral approaches are the safest to yield neurovascular decompression. We described and documented ARDF (anterior VA release, intervertebral distraction and fusion) on a patient case. Level of evidence II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).

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

Cited by 8 publications

References 23 publications

Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case

Microvascular decompression of a vertebral artery loop causing cervical radiculopathy: illustrative case

Tortuous vertebral artery triggering vertebral foramen expansion and radiculopathy in a 19-year-old patient: a case report

Anterior artery release, distraction and fusion (ARDF) for radiculopathy caused by a vertebral artery loop

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