gms | German Medical Science

Vertebral artery tortuosity or loop formation is an unusual cause of cervical radiculopathy and vertebrobasilar insufficiency. Whether congenital or acquired, it has been reported to occur equally in both sexes and it is usually an incidental finding discovered during the search for the cause of cervical pain and occipitocervical neuralgia. The literature is sparse on this topic, and apart from various operative procedures being described in case reports, conservative approaches have shown equally favourable outcomes. We present the case of a patient suffering from cervical monoradiculopathy due to a loop formation of the right vertebral artery at the level C4-5, which was treated successfully by ventral neurovascular decompression.

The 72-year-old patient underwent a decompression of the C5 nerve root and the compressing vertebral artery loop at the level C4-5 using a ventral approach. After drilling away parts of the transverse process of C5 in the vicinity, both structures were exposed and separated, without further mobilisation of the loop or vascular reconstruction.

Postoperatively, the patient’s symptoms resolved completely and there were no signs of recurrence within the follow-up period.

This is the first description of a successful anterior vascular decompression of a vertebral artery loop producing cervical radiculopathy, in contrast to previously published case reports of intended or accidentally performed posterior decompression or vascular reconstruction. This proposed approach and technique is easy to perform, necessitates less bone removal than posterior approaches especially of the facet joint, while enabling sufficient exposure of the neurovascular conflict, and seems an effective, minimal-invasive therapeutic choice for this rare entity.