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

Introduction: 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. Research question: To highlight the rare occurrence of cervical radiculopathy caused by an ectatic vertebral artery and discuss its surgical management. Material and methods: 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. Results: Post-surgery, the patient showed significant symptom improvement, including increased deltoid power and reduced pain. Radiological follow-up confirmed successful decompression. Discussion and conclusion: 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.