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- Title
Cervicobrachial neuralgia due to vertebral artery loop.
- Authors
Rigal, Marine; Portet, Sylvain; Jouanneau, Emmanuel; Riva, Roberto; Eker, Omer; Jacquesson, Timothée
- 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.
- Subjects
VERTEBRAL artery; COMPUTED tomography; NEURALGIA; DIFFERENTIAL diagnosis; SPINAL surgery; CERVICO-brachial neuralgia; SURGICAL decompression; MAGNETIC resonance imaging; INTERVERTEBRAL disk
- Publication
Surgical & Radiologic Anatomy, 2022, Vol 44, Issue 2, p223
- ISSN
0930-1038
- Publication type
Article
- DOI
10.1007/s00276-022-02885-z