Matsumoto Hiroaki, Yamaura Ikuya, Matsumoto Atsushi, Miyata Shiro, Tomogane Yusuke, Minami Hiroaki, Masuda Atsushi, Yoshida Yasuhisa
J Neurosurg Case Lessons. 2023 Apr 17;5(16). doi: 10.3171/CASE2334.
Cervical radiculopathy due to extracranial vertebral artery dissection (VAD) is extremely rare. The disease is usually treated with conservative treatment because of its favorable prognosis. However, there is a possibility that conservative treatment may bring about no improvement in radiculopathy. Although stent placement with a flow diversion effect may be effective in such cases, there are no reported cases that were treated with stent placement.
A 40-year-old healthy man presented with severe right neck pain, right arm pain, and right arm weakness after cracking his neck. A neurological examination revealed right C5 radiculopathy. Neuroimaging studies revealed right extracranial VAD. The VAD compressed the right C5 nerve root. Although medications were administered, there was no improvement in the symptoms. He experienced severe radicular pain. The authors performed stent placement with a flow diversion effect 10 days after the onset of VAD. His radicular pain improved immediately after the procedure, and the remaining radiculopathy completely improved within 1 month. Follow-up angiography showed complete improvement of the VAD.
Stent placement with a flow diversion effect may be considered when radiculopathy that hinders a patient's daily life exists. Stent placement may bring about rapid improvement in radiculopathy, especially radicular pain.
颅外椎动脉夹层（VAD）导致的神经根型颈椎病极为罕见。由于其预后良好，该病通常采用保守治疗。然而，保守治疗有可能无法改善神经根病症状。尽管具有血流导向作用的支架置入术在此类病例中可能有效，但尚无采用支架置入术治疗的报道病例。
一名40岁健康男性在颈部扭伤后出现严重的右侧颈部疼痛、右臂疼痛和右臂无力。神经系统检查显示右侧C5神经根病。神经影像学研究显示右侧颅外VAD。VAD压迫右侧C5神经根。尽管给予了药物治疗，但症状并无改善。患者经历了严重的神经根性疼痛。作者在VAD发病10天后进行了具有血流导向作用的支架置入术。术后患者的神经根性疼痛立即改善，其余神经根病症状在1个月内完全改善。随访血管造影显示VAD完全改善。
当存在妨碍患者日常生活的神经根病时，可考虑采用具有血流导向作用的支架置入术。支架置入术可能会使神经根病迅速改善，尤其是神经根性疼痛。
