European Spine Journal

, Volume 28, Issue 2, pp 292–296 | Cite as

Double crush syndrome caused by cervical spondylosis and vertebral artery loop

  • Young Joon Rho
  • Woo Jin ChoeEmail author
Grand Rounds


Open image in new window Purpose

The purpose of this article is to report a successful treatment experience in a rare case of simultaneous cervical nerve root compression by spondylotic cervical foraminal stenosis and a vertebral artery loop.


51-year-old man presented with a 4-year history of left-sided cervical pain radiating to the left shoulder with progressive exacerbation of weakness on left shoulder girdle muscles for 7 months. The patient had no history of trauma. The patient’s CT and MRI revealed impingement of the left C6 cervical nerve root by a tortuous vertebral artery loop and also by narrowed left C5–6 cervical foramen that had undergone spondylotic changes. The patient underwent left C5–6 hemilaminectomy, facetectomy and C5–6 fusion. The procedures were uneventful, and the patient recovered with complete resolution of symptoms.


The patient continued to be asymptomatic at a 2-year follow-up examination, and the muscle mass of his left girdle returned normal.


This report illustrates the first phenomenon of a double crush syndrome caused by vertebral artery loop and cervical spondylotic changes. When patients with cervical spondylosis present with unexplainably severe pain and weakness, additional underlying pathologies should be considered when making differential diagnoses. The investigation planning should involve electromyography, computed tomography angiography, and magnetic resonance imaging.


Crush syndrome Vertebral artery Loop Cervical spondylosis 


Compliance with ethical standards

Conflict of interest

This paper was written as part of Konkuk University’s research support program for its faculty.


  1. 1.
    Yousem DM, Atlas SW, Goldberg HI, Grossman RI (1991) Degenerative narrowing of the cervical spine neural foramina: evaluation with high-resolution 3DFT gradient-echo MR imaging. AJNR Am J Neuroradiol 12:229–236PubMedGoogle Scholar
  2. 2.
    Duthel R, Tudor C, Motuo-Fotso MJ, Brunon J (1994) Cervical root compression by a loop of the vertebral artery: case report. Neurosurgery 35:140–142CrossRefPubMedGoogle Scholar
  3. 3.
    Epstein NE, Silvergleid R (1995) Magnetic resonance angiographic diagnosis of ectatic vertebral artery. J Spinal Disord 8:308–310CrossRefPubMedGoogle Scholar
  4. 4.
    Freilich M, Virapongse C, Kier EL, Sarwar M, Bhimani S (1986) Foramen transversarium enlargement due to tortuosity of the vertebral artery. Computed tomographic appearance. Spine 11:95–98CrossRefPubMedGoogle Scholar
  5. 5.
    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 CrossRefPubMedGoogle Scholar
  6. 6.
    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 25:2860–2864CrossRefPubMedGoogle Scholar
  7. 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 CrossRefPubMedGoogle Scholar
  8. 8.
    Ganiyusufoglu K, Kantarci M, Sirvanci M, Sildiroglu O, Alparslan L (2005) Cervical radiculopathy caused by vertebral artery loop formation: multislice computed tomography angiography findings. J Comput Assist Tomogr 29:133–135CrossRefPubMedGoogle Scholar
  9. 9.
    Kivrak AS, Koc O, Emlik D, Kiresi D, Odev K, Kalkan E (2009) Differential diagnosis of dumbbell lesions associated with spinal neural foraminal widening: imaging features. Eur J Radiol 71:29–41. doi: 10.1016/j.ejrad.2008.03.020 CrossRefPubMedGoogle Scholar
  10. 10.
    Upton AR, McComas AJ (1973) The double crush in nerve entrapment syndromes. Lancet 2:359–362CrossRefPubMedGoogle Scholar
  11. 11.
    Kane PM, Daniels AH, Akelman E (2015) Double Crush Syndrome. J Am Acad Orthop Surg 23:558–562. doi: 10.5435/JAAOS-D-14-00176 CrossRefPubMedGoogle Scholar
  12. 12.
    Nemoto K, Matsumoto N, Tazaki K, Horiuchi Y, Uchinishi K, Mori Y (1987) An experimental study on the “double crush” hypothesis. J Hand Surg 12:552–559CrossRefGoogle Scholar
  13. 13.
    Dellon AL, Mackinnon SE (1991) Chronic nerve compression model for the double crush hypothesis. Ann Plast Surg 26:259–264CrossRefPubMedGoogle Scholar
  14. 14.
    Schmid AB, Coppieters MW (2011) The double crush syndrome revisited–a Delphi study to reveal current expert views on mechanisms underlying dual nerve disorders. Manual Therap 16:557–562. doi: 10.1016/j.math.2011.05.005 CrossRefGoogle Scholar
  15. 15.
    Korinth MC, Mull M (2007) Vertebral artery loop causing cervical radiculopathy. Surg Neurol 67:172–173. doi: 10.1016/j.surneu.2006.03.047 CrossRefPubMedGoogle Scholar
  16. 16.
    Yousry TA, Seelos K, Widenka DC, Steiger HJ (1996) Vertebral artery loop causing cervical compression. AJNR Am J Neuroradiol 17:1800–1801PubMedGoogle Scholar
  17. 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 CrossRefPubMedGoogle Scholar
  18. 18.
    Vincentelli F, Caruso G, Rabehanta PB, Rey M (1991) Surgical treatment of a rare congenital anomaly of the vertebral artery: case report and review of the literature. Neurosurgery 28:416–420CrossRefPubMedGoogle Scholar
  19. 19.
    Anderson RE, Shealy CN (1970) Cervical pedicle erosion and rootlet compression caused by a tortuous vertebral artery. Radiology 96:537–538. doi: 10.1148/96.3.537 CrossRefPubMedGoogle Scholar
  20. 20.
    Sakaida H, Okada M, Yamamoto A (2001) Vascular reconstruction of a vertebral artery loop causing cervical radiculopathy and vertebrobasilar insufficiency. Case report. J Neurosurg 94:145–149PubMedGoogle Scholar
  21. 21.
    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 CrossRefPubMedGoogle Scholar
  22. 22.
    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 21:1085–1089CrossRefPubMedGoogle Scholar
  23. 23.
    Denis F (1983) The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine 8:817–831CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Department of NeurosurgeryKonkuk University School of MedicineSeoulKorea

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