Abstract
Purpose
The main anatomic variations should be taught along with the classical anatomy curriculum, since they can mislead both diagnosis and treatment. We report here a clinical and radiological case of left C6 cervicobrachial neuralgia recurrence due to a vertebral artery loop, we then describe 13 published cases of such neurovascular conflicts.
Case
A 51-year-old woman suffered from recurrence of C6 cervicobrachial neuralgia after an initial C5–C6 decompression–fusion. Additional cervical angio-MR and CT scans found a tortuous aspect of the left vertebral artery that came into conflict with the left C6 spinal root, just after its emergence of the C5–C6 intervertebral foramen. A large posterior decompression was performed including a C5 and C6 left lateral mass resection to enlarge the foraminal space. The vertebral artery was kept in place. The patient reported a slow but consistent decrease in pain that disappeared after 3 months. Thirteen cases of a compressive vertebral loop are thereafter detailed.
Conclusions and discussion
Vascular precursors disarrangements can lead to a vertebral artery loop in contact with emerging cervical roots and potential clinical impact. This differential diagnosis should be considered for cervico-brachial neuralgia management. Moreover, the present case highlights the key role of a careful preoperative imaging assessment, as well as the need for robust knowledge of anatomy.
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Abbreviations
- 3D:
-
Three dimensions
- CT:
-
Computed tomography
- MRI:
-
Magnetic resonance imaging
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Acknowledgements
We thank Dr. Philip Robinson for English editing.
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Contributions
MR: literature review, manuscript writing, figures editing. SP: surgical strategy, surgery expertise, manuscript reviewing. EJ: surgical strategy, manuscript reviewing. RR: imaging, manuscript reviewing. OE: imaging, case management. TJ: surgery, figures editing, final manuscript reviewing.
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Rigal, M., Portet, S., Jouanneau, E. et al. Cervicobrachial neuralgia due to vertebral artery loop. Surg Radiol Anat 44, 223–226 (2022). https://doi.org/10.1007/s00276-022-02885-z
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DOI: https://doi.org/10.1007/s00276-022-02885-z