Resident St. Luke's Medical Center - Quezon City and Global City
Introduction: Vertebral artery loop formations (VALFs) are underreported yet treatable causes of cervical radiculopathy. [1-13]. Incidence varies between 2-7.5%. Exact pathogenesis is unclear. Literature is sparse [2,14,7,15] and optimal treatment remains controversial. This review therefore, aims to collect all available literature describing symptomatic vertebral artery loops. In addition, we present the first documented case of a Filipino patient with symptomatic multilevel VALFs.
Methods: We performed a scoping review of literature in PubMed, British Medical Journal and New England Journal of Medicine. Full text original, descriptive and analytical studies of symptomatic VALF patients were collated. Data from retrieved articles were collaboratively reviewed, systematically tabulated and synthesized through thematic analysis, paired T-test and Chi Square Test.
Results: A total of 30 articles and 30 patients found to have symptomatic vertebral artery loops were included. Mean age of patients was 53 years; of which, 17 (57%) were females. Tortuosity was more apparent on the left side with C5-C6 (31%) as the most common level of affectation. Neck pain (13%) and shoulder pain (26%) were the most common left and right-sided presenting symptoms. In terms of outcome, there was no statistically significant difference among the surgical techniques reported (p = 1.00), and between surgical and conservative management (p = 0.99).
Conclusion : Vertebral artery loops are increasingly recognized as significant causes of cervical radiculopathy. These anomalies are thought to arise from cervical trauma [15,19,20,27,29], hemodynamic stresses or mechanical and degenerative causes. Symptomatic VALFs are either managed conservatively or surgically (posterior, anterior or anterolateral approach). An evolving understanding and prompt clinical recognition of this entity are paramount for effective, patient-tailored and risk-free treatment strategy.
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