Melka Hiwot A, Rivera-Melo Hector, Jordan Simone, Hwang Henry, Whedon James
Spine Institute, Southern California University of Health Sciences, Whittier, California.
Center for Diagnostic Imaging, Southern California University of Health Sciences, Whitter, California.
J Chiropr Med. 2020 Mar;19(1):65-69. doi: 10.1016/j.jcm.2019.10.002. Epub 2020 Sep 3.
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.
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.
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.
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.
椎动脉（VA）异常（如迂曲/成袢及假性动脉瘤）导致颈椎侵蚀的情况罕见，但这两种异常都有潜在致命风险。关于VA异常导致颈椎椎体侵蚀的报道很少。我们报告一例92岁女性患者，她因颈部疼痛就诊于初级保健医生，后被转诊接受脊椎按摩治疗。
患者主诉头痛、左侧颈部疼痛、活动范围受限伴放射性疼痛以及双侧上肢无力。检查时，颈椎活动范围减小，伴有中度疼痛，同时存在感觉、运动及深腱反射减退。最初获得的磁共振成像报告不明确。获取了颈椎的轴向T2、矢状T1、矢状T2、冠状T2、矢状短TI反转恢复（STIR）及轴向梯度回波（GE）序列图像进行再次阅片。再次阅片的磁共振图像提示诊断为VA迂曲，导致C5椎体慢性侵蚀；然而，VA假性动脉瘤也被认为是椎体侵蚀的一个可能鉴别病因。
VA异常导致颈椎椎体侵蚀的治疗通常很复杂，必须根据每个患者的个体临床表现和症状进行调整。本例患者采用抗凝药物、密切监测及针灸治疗，疼痛强度有所减轻。
椎动脉异常及随后的椎体侵蚀是一种罕见情况，可模仿肌肉骨骼性颈部疼痛和颈椎神经根病的症状。在磁共振成像上识别VA异常的特征很重要。
