Objective: The occurrence of cervical vertebral erosion due to vertebral artery (VA) abnormalities such as tortuosity/loop formation and pseudoaneurysm is rare, but both abnormalities are potentially fatal. There are few reports of cervical vertebral body erosion due to VA abnormality. We report a case of a 92-year-old woman who presented to her primary care physician with neck pain and was referred for chiropractic care.
Clinical Features: The patient complained of headaches, left-sided neck pain, limited range of motion with radiating pain, and bilateral weakness of the upper extremities. On examination, cervical ranges of motion were decreased with moderate pain, along with sensory, motor, and deep tendon reflex deficits. The initial magnetic resonance imaging report obtained was nonconclusive. Axial T2, sagittal T1, sagittal T2, coronal T2, sagittal STIR, and axial GE sequences of the cervical spine were obtained for a reread. A reread of the magnetic resonance images suggested a diagnosis of a tortuosity of the VA, resulting in a chronic erosion of the C5 vertebral body; however, a pseudoaneurysm of the VA would be considered a possible differential cause for the vertebral body erosion
Intervention and Outcome: Management of cervical vertebral body erosion due to VA abnormality is often complicated and must be tailored to each patient's individual clinical presentation and symptoms. The patient in this case was managed with anticoagulant medication, close monitoring, and acupuncture treatment, which resulted in a reduction in pain intensity.
Conclusion: Vertebral artery abnormality and subsequent erosion of the vertebral body is a rare occurrence and can mimic symptoms of musculoskeletal neck pain and cervical radiculopathy. It is important to recognize features of VA abnormalities on magnetic resonance imaging.
Author keywords: Safety; Magnetic Resonance Imaging; Vertebral Artery; Cervical Spine; Erosion
Author affiliations: HAM: Spine Institute, Southern California University of Health Sciences, Whittier, California, United States; HR-M, SJ: Center for Diagnostic Imaging, Southern California University of Health Sciences, Whitter, California, United States; HH: College of Eastern Medicine, Southern California University of Health Sciences, Whitter, California, United States; JW: Health Services Research, Southern California University of Health Sciences, Whitter, California, United States
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