Skip to main content

Advertisement

Log in

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

European Spine Journal Aims and scope Submit manuscript

Abstract

Background

Cervical radiculopathies are rarely caused by vertebral artery loop formation, which is estimated to be present in less than 3% of patients. It is uncertain what causes the loop formation: some propose an association with spondylotic changes or trauma, whilst others suggest hypertension and atherosclerosis may be responsible.

Case report 1

A 35-year-old male patient presented with signs and symptoms of cervical radiculopathy that was not improved with anterior cervical discectomy and fusion surgery performed 2 years beforehand. Vertebral artery loop was discovered at the level C5/6 on the MRI. Vertebral artery transposition surgery via a lateral approach was performed at the level of the left C5/6 for symptoms of left C6 radiculopathy. Deroofing of the transverse process was performed with post-surgical complete improvement in weakness and pain.

Case report 2

A 48-year-old female patient presented with a 10-year history of left shoulder pain with occasional radiation into her middle three fingers accompanied by intermittent paraesthesia and weakness. Numerous shoulder surgeries, Botox injections and suprascapular nerve blocks had not provided any significant benefit. A vertebral artery loop was identified at the level of C3/4 and C4/5 on the left with cervical MRI. Transposition surgery of these two levels provided some post-surgical improvement in pain.

Conclusion

Vertebral artery loop formations are a rare but potential cause for cervical radiculopathy. In two cases, the loop formations were not radiographically reported on MRI, thus clinicians should be aware of this as a differential diagnosis in the management of cervical radiculopathy. The presented surgical approach may be useful in managing future cases of vertebral artery loop formation causing cervical radiculopathy resistant to conservative measures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

References

  1. Park SB, Yang HJ, Lee SH (2012) Medial loop of v2 segment of vertebral artery causing compression of proximal cervical root. J Korean Neurosurg Soc 52:513–516. doi:10.3340/jkns.2012.52.6.513

    Article  PubMed  PubMed Central  Google Scholar 

  2. Hage ZA, Amin-Hanjani S, Wen D, Charbel FT (2012) Surgical management of cervical radiculopathy caused by redundant vertebral artery loop. J Neurosurg Spine 17:337–341. doi:10.3171/2012.7.spine123

    Article  PubMed  Google Scholar 

  3. Hadley LA (1958) Tortuosity and deflection of the vertebral artery. Am J Roentgenol Radium Ther Nucl Med 80:306–312

    CAS  PubMed  Google Scholar 

  4. Paksoy Y, Levendoglu FD, Ogun CO, Ustun ME, Ogun TC (2003) Vertebral artery loop formation: a frequent cause of cervicobrachial pain. Spine 28:1183–1188. doi:10.1097/01.brs.0000067275.08517.58

    Article  PubMed  Google Scholar 

  5. Curylo LJ, Mason HC, Bohlman HH, Yoo JU (2000) Tortuous course of the vertebral artery and anterior cervical decompression: a cadaveric and clinical case study. Spine 25:2860–2864

    Article  CAS  Google Scholar 

  6. Doweidar A, Al-Sayed S, Al-Kandery S (2014) Symptomatic vertebral artery loop: a case report and review of literature. J Radiol Case Rep 8:35–41. doi:10.3941/jrcr.v8i5.1407

    Article  PubMed  PubMed Central  Google Scholar 

  7. Detwiler PW, Porter RW, Harrington TR, Sonntag VK, Spetzler RF (1998) Vascular decompression of a vertebral artery loop producing cervical radiculopathy. Case report. J Neurosurg 89:485–488. doi:10.3171/jns.1998.89.3.0485

    Article  CAS  PubMed  Google Scholar 

  8. Benny BV, Nagpal AS, Singh P, Smuck M (2011) Vascular causes of radiculopathy: a literature review. Spine J 11:73–85. doi:10.1016/j.spinee.2010.09.027

    Article  PubMed  Google Scholar 

  9. Oga M, Yuge I, Terada K, Shimizu A, Sugioka Y (1996) Tortuosity of the vertebral artery in patients with cervical spondylotic myelopathy. Risk factor for the vertebral artery injury during anterior cervical decompression. Spine 21:1085–1089

    Article  CAS  Google Scholar 

  10. Sakaida H, Okada M, Yamamoto A (2001) Vascular reconstruction of a vertebral artery loop causing cervical radiculopathy and vertebrobasilar insufficiency. Case report. J Neurosurg 94:145–149

    CAS  PubMed  Google Scholar 

  11. Nurmikko TJ, Eldridge PR (2001) Trigeminal neuralgia—pathophysiology, diagnosis and current treatment. Br J Anaesth 87:117–132

    Article  CAS  Google Scholar 

  12. Chibbaro S, Mirone G, Yasuda M, Marsella M, Di Emidio P, George B (2012) Vertebral artery loop—a cause of cervical radiculopathy. World Neurosurg 78:e311–e373. doi:10.1016/j.wneu.2011.12.002

    Article  Google Scholar 

  13. Korinth MC, Mull M (2007) Vertebral artery loop causing cervical radiculopathy. Surg Neurol 67:172–173. doi:10.1016/j.surneu.2006.03.047

    Article  PubMed  Google Scholar 

  14. Duthel R, Tudor C, Motuo-Fotso MJ, Brunon J (1994) Cervical root compression by a loop of the vertebral artery: case report. Neurosurgery 35:140–142

    Article  CAS  Google Scholar 

  15. Horgan MA, Hsu FP, Frank EH (1998) Cervical radiculopathy secondary to a tortuous vertebral artery. Case illustration. J Neurosurg 89:489. doi:10.3171/jns.1998.89.3.0489

    Article  CAS  PubMed  Google Scholar 

  16. Kim HS, Lee JH, Cheh G, Lee SH (2010) Cervical radiculopathy caused by vertebral artery loop formation: a case report and review of the literature. J Korean Neurosurg Soc 48:465–468. doi:10.3340/jkns.2010.48.5.465

    Article  PubMed  PubMed Central  Google Scholar 

  17. Sharma RR, Parekh HC, Prabhu S, Gurusinghe NT, Bertolis G (1993) Compression of the C-2 root by a rare anomalous ectatic vertebral artery. Case report. J Neurosurg 78:669–672. doi:10.3171/jns.1993.78.4.0669

    Article  CAS  PubMed  Google Scholar 

  18. Verbiest H (1969) Anterolateral operations for fractures and dislocations in the middle and lower parts of the cervical spine. Report of a series of forty-seven cases. J Bone Joint Surg Am 51:1489–1530

    Article  CAS  Google Scholar 

  19. Verbiest H (1970) Anterolateral operations for fractures and dislocations in the middle and lower parts of the cervical spine. Acta Neurochir 22:261–265

    CAS  PubMed  Google Scholar 

  20. Szapiro J Jr, Sindou M (1986) Microsurgical treatment of trigeminal neuralgia. Results and prognostic factors of microsurgical vascular decompression. Neurochirurgie 32:103–121

    PubMed  Google Scholar 

  21. Szapiro J Jr, Sindou M, Szapiro J (1985) Prognostic factors in microvascular decompression for trigeminal neuralgia. Neurosurgery 17:920–929

    Article  Google Scholar 

  22. Capelle HH, Brandis A, Tschan CA, Krauss JK (2010) Treatment of recurrent trigeminal neuralgia due to Teflon granuloma. J Headache Pain 11:339–344. doi:10.1007/s10194-010-0213-4

    Article  PubMed  PubMed Central  Google Scholar 

  23. Chen J, Lee S, Lui T, Yeh Y, Chen T, Tzaan W (2000) Teflon granuloma after microvascular decompression for trigeminal neuralgia. Surg Neurol 53:281–287

    Article  CAS  Google Scholar 

  24. Deep NL, Graffeo CS, Copeland WR 3rd, Link MJ, Atkinson JL, Neff BA, Raghunathan A, Carlson ML (2016) Teflon granulomas mimicking cerebellopontine angle tumors following microvascular decompression. Laryngoscope. doi:10.1002/lary.26126

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bronek M. Boszczyk.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wood, L., Czyz, M., Forster, S. et al. The diagnosis and management of a vertebral artery loop causing cervical radiculopathy. Eur Spine J 30, 1–6 (2021). https://doi.org/10.1007/s00586-017-5123-6

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-017-5123-6

Keywords

Navigation