# Anomalous vertebral artery course causing radiculopathy: A case report and review of relevant literature

## TL;DR

A rare case of cervical radiculopathy caused by an unusual vertebral artery is reported, highlighting the need for careful pre-surgery planning to avoid complications.

## Contribution

This case report adds to the limited literature on managing cervical radiculopathy caused by vertebral artery anomalies.

## Key findings

- An ectatic vertebral artery at C4/5 was identified as the cause of cervical radiculopathy in a 73-year-old patient.
- Minimally invasive surgery with advanced imaging techniques successfully improved symptoms and confirmed decompression.
- Preoperative identification of vertebral artery anomalies is crucial to prevent surgical complications.

## Abstract

Cervical radiculopathy typically results from degenerative disc disease, but rarely, an ectatic vertebral artery can cause it. This case report and literature review examine a unique instance of cervical radiculopathy due to an anomalous vertebral artery. Vertebral artery loop formation (VALF) is uncommon but can significantly impact surgical outcomes and poses a risk during cervical spine surgeries if unidentified preoperatively.

To highlight the rare occurrence of cervical radiculopathy caused by an ectatic vertebral artery and discuss its surgical management.

A 73-year-old female with left shoulder pain and C5 nerve root palsy underwent radiological evaluation, revealing an ectatic vertebral artery at C4/5. Treatment involved posterior tubular minimally invasive laminoforaminotomy with microvascular decompression, using intraoperative ultrasound and indocyanine green (ICG) angiography to ensure artery patency.

Post-surgery, the patient showed significant symptom improvement, including increased deltoid power and reduced pain. Radiological follow-up confirmed successful decompression.

This case emphasizes the importance of recognizing vertebral artery anomalies in cervical radiculopathy cases without apparent disc pathology. Preoperative identification and appropriate surgical planning are crucial to prevent iatrogenic injury. The successful outcome contributes to the limited literature on managing such cases and highlights the effectiveness of minimally invasive surgical approaches combined with advanced imaging techniques. Surgeons should consider anomalous vertebral artery courses as a potential cause of cervical radiculopathy, especially when conventional pathology is absent.

•Vertebral artery loop formation, though rare, can significantly impact surgical outcomes.•Preoperative identification of vertebral artery anomalies is crucial to prevent iatrogenic injury during cervical spine surgeries.•Appropriate surgical planning and careful technique are essential when managing these uncommon cases.

Vertebral artery loop formation, though rare, can significantly impact surgical outcomes.

Preoperative identification of vertebral artery anomalies is crucial to prevent iatrogenic injury during cervical spine surgeries.

Appropriate surgical planning and careful technique are essential when managing these uncommon cases.