scholarly journals Anterior artery release, distraction and fusion (ARDF) for radiculopathy caused by a vertebral artery loop

2021 ◽  
Author(s):  
Mazda Farshad ◽  
José Miguel Spirig ◽  
Marco D. Burkhard
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Loop Formation ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Surgical Strategies ◽  
History Of ◽  
The Right ◽  
Neurovascular Decompression

Abstract Background Anomalous vertebral artery (VA) with loop formation is a rare cause of cervical nerve root compression. Various techniques with anterior and posterior approaches have been described for surgical treatment once conservative treatments fail. We herein present a case treated with the new technique of anterior release, distraction and fusion (ARDF) and further provide an updated review of surgically managed VA loops in the subaxial spine. Case description A 76-year-old female complained of a 6-year history of pulsating, shooting pain in her right arm to the thumb. After obtaining repeated MRI, the VA loop compressing the right-sided C6-nerve root was detected. A neurovascular decompression through ARDF which led to an indirect loop straightening was performed. The patient immediately improved after surgery and remained pain-free 1 year postoperative. Conclusion Neural irritation due to VA loop formation is a rare cause of cervical radiculopathy. While various surgical strategies have been described, we believe that anterior and anterolateral approaches are the safest to yield neurovascular decompression. We described and documented ARDF (anterior VA release, intervertebral distraction and fusion) on a patient case. Level of evidence II (Diagnostic: individual cross-sectional studies with consistently applied reference standard and blinding).

Vascular decompression of a vertebral artery loop producing cervical radiculopathy

1998 ◽  
Vol 89 (3) ◽  
pp. 485-488 ◽  
Author(s):  
Paul W. Detwiler ◽  
Randall W. Porter ◽  
Timothy R. Harrington ◽  
Volker K. H. Sonntag ◽  
Robert F. Spetzler
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Vascular Structure ◽  
Loop Formation ◽  
Content Type ◽  
History Of ◽  
Radicular Symptoms ◽  
The Right ◽  
Vascular Decompression

✓ Vertebral artery tortuosity and loop formation are rare causes of cervical radiculopathy. The authors present the case of a 70-year-old man with 9 years of progressive right-sided cervical and scapular pain but no history of trauma. Computerized tomography myelography and magnetic resonance imaging revealed an ovoid mass in the right C3–4 intervertebral foramen. The patient underwent a right C-3 and C-4 hemilaminectomy and a complete C3–4 facetectomy. A pulsatile vascular structure was found compressing the right C-4 nerve root. The bone overlying the vascular structure was removed, producing decompression of the nerve root. Immediate postoperative angiography showed that this lesion was a focal vertebral artery loop. The patient's symptoms resolved after surgery, supporting the use of vascular decompression of a cervical nerve root compressed by a vertebral artery loop for the relief of radicular symptoms.

Surgical management of cervical radiculopathy caused by redundant vertebral artery loop

2012 ◽  
Vol 17 (4) ◽  
pp. 337-341 ◽  
Author(s):  
Ziad A. Hage ◽  
Sepideh Amin-Hanjani ◽  
Dennis Wen ◽  
Fady T. Charbel
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Cervical Radiculopathy ◽  
Surgical Approaches ◽  
Anterolateral Approach ◽  
Transverse Foramen ◽  
History Of ◽  
The Right ◽  
Almost All ◽  
Vascular Decompression

In this article, the authors describe the case of a 27-year-old female presenting with a 2-year history of neck pain and radiculopathy attributable to compression of the right C-7 nerve root by tortuosity of the vertebral artery at the level of the C6–7 cervical foramina. An anterolateral approach to the transverse foramen was used to perform a vascular decompression to decompress the nerve root. The procedure was uneventful, and the patient woke up with almost all of her symptoms resolved. The authors also include a literature review of techniques performed in this setting, showing that multiple surgical approaches can be used and should be tailored to the patient symptoms and lesion characteristics.

scholarly journals Tortuous vertebral artery triggering vertebral foramen expansion and radiculopathy in a 19-year-old patient: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Ibrahim F. Naldemir ◽  
Elif Nisa Unlu ◽  
Omer Onbas
Keyword(s):  
Case Report ◽  
Magnetic Resonance ◽  
Vertebral Artery ◽  
Cerebral Arteries ◽  
Cervical Radiculopathy ◽  
The Elderly ◽  
Loop Formation ◽  
Arterial Tortuosity ◽  
Turkish Patient ◽  
The Right

Abstract Background Arterial tortuosity is a widespread condition commonly occurring in cerebral arteries and often associated with the elderly. Moderate arterial tortuosity is often not symptomatic, but if there is severe tortuosity, various symptoms may occur, depending on the localization. In the literature, many factors have been reported as causing tortuosity in the vertebral arteries. In this case report, considering the age of our patient, we propose that, in addition to these previously reported reasons, congenital factors may also contribute to this situation. Case presentation We present a case of a 19-year-old Turkish patient with a tortuous vertebral artery causing pain and tingling in the right shoulder and neck. Magnetic resonance imaging revealed vertebral foramen enlargement thought to be secondary to a loop formation in the vertebral artery. The diagnosis was confirmed by magnetic resonance angiography. Conclusions There are many causes of cervical radiculopathy. Arterial tortuosity, a rare cause of radiculopathy, should be considered as a differential diagnosis. Consideration of the existence of this variation is of great importance in preventing possible dangerous complications during surgery.

Classification of vertebral artery loop formation and association with cervicogenic dizziness

2016 ◽  
Vol 130 (12) ◽  
pp. 1115-1119 ◽  
Author(s):  
A Yenigun ◽  
M E Ustun ◽  
S Tugrul ◽  
R Dogan ◽  
O Ozturan
Keyword(s):  
Retrospective Study ◽  
Vertebral Artery ◽  
Pulsatile Tinnitus ◽  
Loop Formation ◽  
Cross Sectional ◽  
Positional Vertigo ◽  
Artery Segment ◽  
The Right ◽  
Cervicogenic Dizziness

AbstractObjective:An examination was conducted of the number, level, clinical association and treatment approaches for vertebral arterial loop formation in patients with this condition with and without concurrent cervicogenic dizziness, and classified them according to the vertebral artery segment in which it was present.Method:A cross-sectional retrospective study.Results:Thirty-seven patients who had undergone double-sided magnetic resonance angiography were examined; vertebral arterial loop formation was observed at only 1 level in 26 patients and at several levels in 9 patients. Segment one (V1) was involved in 78.3 per cent of cases and segment two (V2) was involved in 21.6 per cent. Symptoms in patients with vertebral arterial loop formation included: positional vertigo, in 100 per cent; and pulsatile tinnitus, in 83.7 per cent.Conclusion:Loop formation at the vertebral artery was observed most often on the proximal side in patients with cervicogenic dizziness (78.3 per cent). The incidence on the left side was twice as high as on the right side.

Bow Hunter's Syndrome: Complete Microsurgical Decompression of Vertebral Artery by Far Lateral Retrocondylar Approach: 3-Dimensional Operative Video

2019 ◽  
Author(s):  
Qazi Zeeshan ◽  
Juan P Carrasco Hernandez ◽  
Laligam N Sekhar
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Dynamic Compression ◽  
Skin Incision ◽  
Left Vertebral Artery ◽  
Occipital Condyle ◽  
Cerebral Angiogram ◽  
Microsurgical Decompression ◽  
C2 Nerve Root ◽  
The Right

Abstract This 50-yr-old man had a 15-yr history of presyncopal episodes that were precipitated by turning his head to the right, and had worsened recently. Cerebral angiogram demonstrated complete cessation of anterograde flow in left vertebral artery (VA) at the level of the C1 sulcus arteriosus while turning head to right, indicating dynamic compression at the C1 level.  Patient underwent left extreme lateral retrocondylar approach, partial C1 laminectomy and opening of the C1 foramen with complete microsurgical decompression of the VA. After skin incision, meticulous muscle dissection was performed and superior and inferior oblique muscles were disconnected from the tubercle of C1. The VA was exposed, and three areas of constriction were visible, first at the atlanto-occipital membrane laterally; second, located more medially as the artery curved around the occipital condyle to enter the posterior fossa; and third, located anterior to C2 nerve root. The artery was dissected from all the surrounding tissues, preserving the C2 nerve root, and the Cl foramen was opened completely. The Cl lamina was also partially resected and grooved to allow free placement of the VA. The VA was also decompressed near the C2 foramen. Postoperative computed tomography angiogram of the head and neck showed complete decompression of VA. The patient had no episodes of presyncope or dizziness while turning head to right and his mRs was 0 at 8 mo follow up.  This 3D video shows the technical nuances of decompression of V3 segment of VA in bow hunters's syndrome.  Informed consent was obtained from the patient prior to the surgery that included videotaping of the procedure and its distribution for educational purposes. All relevant patient identifiers have also been removed from the video and accompanying radiology slides.

scholarly journals Extracranial Vertebral Artery Aneurysm Presenting as a Chronic Cervical Mass Lesion

2010 ◽  
Vol 2010 ◽  
pp. 1-3 ◽  
Author(s):  
Lampis C. Stavrinou ◽  
George Stranjalis ◽  
Pantelis C. Stavrinou ◽  
N. Bontozoglou ◽  
Damianos E. Sakas
Keyword(s):  
Vertebral Artery ◽  
Artery Aneurysm ◽  
Clinical History ◽  
Cervical Radiculopathy ◽  
Artery Occlusion ◽  
Transverse Foramen ◽  
Artery Pseudoaneurysm ◽  
History Of ◽  
Extracranial Vertebral Artery ◽  
Cervical Root

Background. Aneurysms of the extracranial vertebral artery are rare and can provide a diagnostic and therapeutic challenge.Methods. We reviewed the clinical history of a patient presenting with cervical radiculopathy, who harboured an extracranial vertebral artery aneurysm eroding the cervical spine.Results. CT Angiography and MR Angiography set the diagnosis, by revealing a left C5-C6 vertebral artery aneurysm with cervical root impingement. Bony reconstruction depicted enlargement of the C6 transverse foramen and a marked enlargement of the C6-C7 intravertebral foramen. The lesion was treated by intravascular proximal vertebral artery occlusion.Conclusions. Extracranial vertebral artery aneurysms require a high index of clinical suspicion. This is the first report of a vertebral artery pseudoaneurysm presenting with bony erosion, which supports a less minacious portrayal of vertebral artery aneurysms.

scholarly journals Median Nerve Neuritis after Infection by the SARS-CoV-2 Virus

2021 ◽  
Vol 6 (1) ◽  
pp. 1-4
Author(s):  
Marcelo de Pinho Teixeira Alves ◽  
João Pedro Gouveia Nóbrega
Keyword(s):  
Median Nerve ◽  
Metabolic Diseases ◽  
Severe Disease ◽  
Neurological Complications ◽  
Neurological Manifestations ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
First Case ◽  
Asymptomatic Patients ◽  
The Right

Background: The spectrum of neurological complications from SARS-CoV-2 infection is under constant investigation. According to numerous publications, occurrence of neurological complications can be about 36.4%. There are no reports to date of the occurrence of bilateral median nerve neuritis in the wrist after SARS-CoV-2 infection. Case: A previously healthy 24 years old female was observed in March 2021 due to dysesthesias in both hands, associated with nocturnal discomfort and decreased grip strength. The symptoms started a month earlier with acroparesthesias. SARS-CoV-2 virus infection was in January 2021 and evolved favorably, with progressive remission in about 10 days. Prior to the infection she didn’t have any of the hand symptoms; denied diabetes or metabolic diseases. Negative tests for SARS-CoV-2 infection since February. April 2021, the patient returned with persistent dysesthesias in her hands. Normal EMG, however with Sensitive Conduction Speed (SCS) of 50 m/sec on the right wrist; on the left SCS 55 m/sec. Sensitive latency 2.8 on the right and 2.6 on the left. Amplitude 17 on the right and 24 on the left. MRI detected an increase in signal in PDFS sequences in both median nerves, in the carpal tunnel, with no detected variations in cross-sectional areas or masses. The treatment was a 30 days 150 mg benfotiamine in two daily doses. Discussion: There is a wide variation in the clinical presentation of SARS-CoV-2 infection, ranging from asymptomatic patients to death. Most frequent symptoms are fever, dry cough, sore throat, dyspnea, myalgia, fatigue, chills, diarrhea, chest pain and vomiting, and the most common complications pneumonia and acute respiratory distress syndrome. Neurological manifestations of viral infection can occur in about 36.4% and in 45.5% in severe disease. They include Guillán-Barré and Miller Fischer syndrome; however, these conditions usually occur in more severe cases of the disease, but this patient hadn’t the typical picture of ataxia, ophthalmoplegia and areflexia. Benfotiamine is a synthetic derivative of thiamine with a multifaceted therapeutic profile, with a therapeutic role especially in diabetic neuropathy. Conclusion: Knowledge and recognition of neurological manifestations of SARS-CoV-2 infection and early detection of secondary peripheral neuropathies result in improvement of patients' clinical results and development of ideal ways of treatment. Although only a small percentage of patients develop peripheral neuropathy, in a pandemic this can result in a major social and health impact. The reported case is the first case of bilateral secondary median nerve neuritis in the literature. Level of evidence 4.

scholarly journals PREVALENCE AND FACTORS ASSOCIATED WITH INJURIES IN RECREATIONAL RUNNERS: A CROSS-SECTIONAL STUDY

2020 ◽  
Vol 26 (3) ◽  
pp. 215-219 ◽  
Author(s):  
Maria Eduarda Ferreira Costa ◽  
Jader Barbosa Fonseca ◽  
Ana Izabela Sobral de Oliveira ◽  
Kryslly Danielle de Amorim Cabral ◽  
Maria das Graças Rodrigues de Araújo ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Musculoskeletal Injuries ◽  
Sectional Study ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Factors Associated ◽  
Demographic Questionnaire ◽  
Chi Squared ◽  
Running Injuries ◽  
History Of

ABSTRACT Introduction The increased number of people who choose running as a form of exercise has been associated with a higher prevalence of musculoskeletal injuries. Objectives To determine the prevalence and the factors that could be correlated with injuries among amateur runners in Recife, in the State of Pernambuco (PE), Brazil. Methods An observational, cross-sectional study, in which 300 (three hundred) amateur runners answered a social demographic questionnaire, as well as questions about training characteristics, footstrike and landing pattern, and history of running injuries. The data were analyzed by descriptive statistics, the student-t test to compare means, and the Chi-squared to compare prevalences. Results The prevalence of injuries amongst runners in Recife-PE was 58.5% (n= 175), the knee being the most commonly injured site (37.3%). In both groups - runners with and without injuries – there was a higher number of male runners, with 72.4% and 72.6% respectively. There was no difference in relation to the weekly frequency of running between the groups (p<0.63). However, runners with a history of injuries ran around 7 kmh a week more than the runners without injuries (p<0.03). A neutral footstrike (F=0.87; p=0.99) and hindfoot landing (F=4.13; p=0.90) were the most reported running patterns in both groups. It was found that wear was the main criterion used for changing running shoes in both groups (F = 8.35, p = 0.4). Conclusion There was a high prevalence of musculoskeletal injuries among amateur runners in Recife-PE. Among the factors associated with the injuries, one variable was significant: a higher weekly volume of training. Level of evidence II; Study type: Cross-sectional study.

Comparison of Static and Dynamic Balance in Male Football and Basketball Players

2019 ◽  
Vol 13 (3) ◽  
pp. 228-235 ◽  
Author(s):  
Farzin Halabchi ◽  
Ladan Abbasian ◽  
Maryam Mirshahi ◽  
Reza Mazaheri ◽  
Mohammad Hosein Pourgharib Shahi ◽  
...  
Keyword(s):  
Ankle Sprain ◽  
Dynamic Balance ◽  
Surface Group ◽  
Balance Performance ◽  
Basketball Players ◽  
Level Of Evidence ◽  
Balance Test ◽  
Cross Sectional ◽  
History Of ◽  
Group 2

Introduction. The aim of the present study was to compare static and dynamic balance among professional athletes in football and basketball. Methods. In this cross-sectional study, 47 professional, male football and basketball players from Pro League in Iran participated. They were divided into 3 groups. Group 1 included 16 participants with history of grade 1 or 2 single ankle sprain within the past 6 months. Group 2 included 17 participants with recurrent ankle sprain. Group 3 included 14 participants without history of ankle sprain. Static and dynamic balance were measured by the Balance Error Scoring System (BESS) and modified Star Excursion Balance Test (SEBT), respectively. Results. For the single-leg stance on a firm surface, group 2 scored errors with a high mean value of 3.94 compared with the other 2 groups, and the difference was statistically significant (P = .03). Significant differences in BESS scores are observed on both surfaces across the tandem limb between groups 2 and 3. Conclusion. The measures from the SEBTs may not reflect the balance performance especially in well-trained athletes who have a better balance when performing sport-related skills. However, BESS includes static postures, and it may reflect postural deficits better than dynamic tests in the more experienced athlete. Level of Evidence: Diagnostic, Level IV

Cervical Dumbbell Intra-extradural Hemangioblastoma: Total Removal through the Lateral Approach: Technical Case Report

Neurosurgery ◽  
2005 ◽  
Vol 56 (3) ◽  
pp. E625-E625 ◽  
Author(s):  
Cédric Barrey ◽  
Michel Kalamarides ◽  
Marc Polivka ◽  
Bernard George
Keyword(s):  
Vertebral Artery ◽  
Nerve Root ◽  
Histopathological Examination ◽  
Lateral Approach ◽  
Primary Control ◽  
Cervical Nerve Root ◽  
Cervical Nerve ◽  
Dumbbell Tumor ◽  
Computed Tomographic ◽  
The Right

Abstract OBJECTIVE AND IMPORTANCE: Extradural hemangioblastomas account for 8 to 12% of all spinal hemangioblastomas. Among them, intra-extradural forms with a dumbbell extension are extremely rare. We report a case of intra-extradural hemangioblastoma involving the C6 cervical nerve root. CLINICAL PRESENTATION: The patient was a 31-year-old woman presenting with signs of myelopathy and C6 radiculopathy on the right side. A computed tomographic scan and magnetic resonance imaging demonstrated a dumbbell tumor that had developed through the C5–C6 intervertebral foramen. Angiography revealed a well-circumscribed mass with feeders from the vertebral artery and the deep cervical artery. INTERVENTION: The tumor was totally removed through the lateral approach, with control of the vertebral artery and sacrifice of the C6 cervical nerve root. Limited bone drilling to enlarge the foramen permitted us to reach and resect the intradural component. Histopathological examination confirmed the diagnosis of hemangioblastoma. Follow-up was uneventful. CONCLUSION: This is the sixth reported case of a cervical dumbbell hemangioblastoma investigated by computed tomographic scanning and MRI but the first one resected via the lateral approach. The lateral approach seems appropriate for surgical resection because it provides primary control of the vascular feeders and access to the extradural and intradural components.

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