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Surgical Decompression of the Vertebral Artery in a Patient with Ponticulus Posticus: a Case Report

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Abstract

Ponticulus posticus (PP) of the cervical vertebrae is an anatomical variant that, in some cases, can result in the obstruction of the vertebral artery (VA) by an osseous ponticle or calcified ligament at C1. Surgical decompression may be required to restore vertebrobasilar blood flow and relieve associated symptoms; however, few reports have described surgical treatment for tethering of the VA due to PP. A 41-year-old man presented with severe unilateral neck pain and dizziness with lightheadedness brought on by head turning to the left. MRI and CT of the cervical spine revealed the VA to be traveling through a complete bony ring on the right side at the C1 level. The patient was initially managed conservatively, but his symptoms persisted, and surgical decompression of the VA was offered. Surgical decompression of the artery was successfully performed and well tolerated without complications. At 3-month follow-up, the patient reported significant improvement of his preoperative symptoms with only mild residual local tenderness in the region. We describe a case of PP in which the VA was tethered in a complete bony ring at C1 producing symptoms, which resolved in large part with surgical decompression. PP anatomical variants may cause debilitating symptoms if vertebrobasilar flow is obstructed, requiring surgical decompression in select cases.

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Acknowledgements

The authors acknowledge Superior Medical Experts for research and drafting assistance.

Funding

This manuscript was supported by the United Hospital Foundation.

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Authors and Affiliations

  1. Twin Cities Spine Center, Minneapolis, MN, USA

    Stefan Yakel & James Schwender

  2. National Brain Aneurysm and Tumor Center, Department of Neurosurgery, United Hospital, 3033 Excelsior Boulevard, Suite 495, Minneapolis, MN, 55416, USA

    Eric S. Nussbaum

  3. University of North Carolina School of Medicine, Chapel Hill, NC, USA

    Puja D. Patel

  4. Gillette Neurosurgery, St. Paul, MN, USA

    Patrick Graupman

  5. Midwest Radiology, St. Paul, MN, USA

    Collin M. Torok

Authors
  1. Stefan Yakel
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  2. Eric S. Nussbaum
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  3. Puja D. Patel
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  4. Patrick Graupman
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  5. Collin M. Torok
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  6. James Schwender
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Contributions

Stefan Yakel, Eric S. Nussbaum, Patrick Graupman, Collin M. Torok, and James Schwender contributed to the conception and design of the study, along with critical review and revision of the manuscript. Puja D. Patel contributed to the study design and analysis along with the drafting of the manuscript. All authors reviewed and approved the final version of the manuscript.

Corresponding author

Correspondence to Eric S. Nussbaum.

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Ethics Approval and Consent to Participate

IRB approval was not required since we present a case report from a private practice.

Conflict of Interest

PP contracts with Superior Medical Experts. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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Informed consent was obtained from the participant included in the study.

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This article is part of the Topical Collection on Surgery

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Yakel, S., Nussbaum, E.S., Patel, P.D. et al. Surgical Decompression of the Vertebral Artery in a Patient with Ponticulus Posticus: a Case Report. SN Compr. Clin. Med. 3, 1994–1997 (2021). https://doi.org/10.1007/s42399-021-00975-4

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  • DOI: https://doi.org/10.1007/s42399-021-00975-4

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