Subaxial rotational vertebral artery syndrome: resection of the uncinate process and anterior fusion can be sufficient!: case report and review of the literature.

STUDY

DESIGN

A case report on rotational vertebral artery syndrome (RVAS) and surgical treatment.

OBJECTIVE

To illustrate a safe treatment option of RVAS with diminished risk of iatrogenic damage to the vertebral artery.

SUMMARY OF BACKGROUND DATA: RVAS is an uncommon cause of symptomatic transient vertebrobasilar insufficiency induced by physiological head rotation with temporary significant external compression of the dominant subaxial vertebral artery. Previous reports state that the treatment of choice consists of decompression of the vessel with resection of the anterior rim of the transverse process and any fibrotic sheet or intertransverse muscle, if necessary, combined with an anterior cervical discectomy and fusion (ACDF) with uncus resection.

METHODS

This is a case report on RVAS and its surgical treatment. The diagnosis of RVAS due to an osteophyte of the uncinate process at level C5/C6 was confirmed using computed tomographic angiography. We performed a classic ACDF using the contralateral approach with complete resection of the uncovertebral joint at the pathologic site.

RESULTS

In our case, the symptoms of transient vertebrobasilar insufficiency induced by head rotation completely resolved postoperatively, and computed tomographic angiography images at 3 months postoperatively showed good bony ingrowth and restoration of vertebral artery patency during extreme rotation.

CONCLUSIONS

Classic ACDF with complete resection of the uncovertebral joint is a safe treatment option for RVAS in the subaxial cervical spine. Fusion at the pathologic level will eliminate rotation and prevent further formation of osteophytes at the operated level. Unroofing of the vertebral artery seems not always necessary, diminishing the surgical risk.