Postoperative subaxial Bow Hunter's syndrome: A rare case triggered by upright posture.

BACKGROUND

Bow Hunter's syndrome (BHS) is typically defined as transient compression of the vertebral artery (VA) during head rotation. Subaxial and postoperative variants are extremely rare.

CASE DESCRIPTION: A 50-year-old male with ankylosing spondylitis developed dizziness and syncope following posterior cervical surgery. His symptoms were triggered not by head rotation but by assuming an upright sitting posture. Imaging demonstrated malalignment at the C4-5 level with the formation of a VA loop. Multilevel anterior cervical discectomy and fusion corrected the deformity, restored vertebrobasilar flow, and led to complete clinical recovery.

CONCLUSION

A 50-year-old male presents with a rare postoperative subaxial variant of BHS provoked by assuming an upright position rather than head rotation. Subaxial VA compression, as highlighted here, should be considered in the differential diagnosis of patients presenting with posture-related dizziness or syncope after posterior cervical surgery.