Symptomatic Vertebral Artery Loop Formations: A Scoping Review of Epidemiology, Pathogenesis, and Treatment
- 1Section of Neurosurgery, Institute for Neurosciences, St. Luke's Medical Center, Quezon City and Global City, Quezon City, Philippines
- 2Division of Neurosurgery, Department of Neurosciences, University of the Philippines -Philippine General Hospital, Manila, Philippines
Abstract
BACKGROUND AND OBJECTIVES:: Vertebral artery loop formations (VALFs) are under-reported yet treatable causes of cervical radiculopathy. Incidence varies between 2% and 7.5%. Exact pathogenesis is unclear. Literature is sparse, and optimal treatment remains controversial. This review aims to collect all available literature describing symptomatic VALFs.
METHODS:: We performed a scoping review in PubMed, Ovid Medline, Cochrane Library, British Medical Journal, and Google Scholar. Full-text original, descriptive, and analytical studies were collated. Data from retrieved articles were collaboratively reviewed, tabulated, and synthesized. Clinical features, diagnosis, and treatment outcomes were discussed.
RESULTS:: A total of 31 articles and 33 patients found to have symptomatic VALFs were included. The mean age of patients was 52 years, 17 (53%) of whom were females. Tortuosity was more apparent on the left, with C4-C5 and C5-C6 (28%) being the most common levels affected. Neck (13%) and shoulder pain (26%) were the most common left- and right-sided presenting symptoms. In the 31 treated patients, 71% (n = 22) underwent surgery, whereas the remaining 29% (n = 9) were treated conservatively. There was complete resolution of symptoms in 54% of patients who underwent surgery and in 75% of patients who were treated conservatively.
CONCLUSION:: Vertebral artery loops are understudied yet clinically significant causes of radiculopathy. Believed to arise from various etiologies, it can be tricky to diagnose and manage, necessitating a high index of suspicion and prompt clinical recognition. When conservative management fails, a patient-tailored surgical approach may provide the most direct decompression with the least associated surgical risks.
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BibTeX
@article{tiangco2026symptomatic,
title = {{Symptomatic Vertebral Artery Loop Formations: A Scoping Review of Epidemiology, Pathogenesis, and Treatment}},
author = {Denisse Ann L. Tiangco and Ibet Marie Y. Sih},
journal = {Neurosurgery Practice},
year = {2026},
month = nov,
doi = {10.1227/neuprac.0000000000000322},
url = {https://doi.org/10.1227/neuprac.0000000000000322},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Symptomatic Vertebral Artery Loop Formations: A Scoping Review of Epidemiology, Pathogenesis, and Treatment
AU - Denisse Ann L. Tiangco
AU - Ibet Marie Y. Sih
PY - 2026
DA - 2026/11/05
JO - Neurosurgery Practice
DO - 10.1227/neuprac.0000000000000322
UR - https://doi.org/10.1227/neuprac.0000000000000322
AB - BACKGROUND AND OBJECTIVES:: Vertebral artery loop formations (VALFs) are under-reported yet treatable causes of cervical radiculopathy. Incidence varies between 2% and 7.5%. Exact pathogenesis is unclear. Literature is sparse, and optimal treatment remains controversial. This review aims to collect all available literature describing symptomatic VALFs. METHODS:: We performed a scoping review in PubMed, Ovid Medline, Cochrane Library, British Medical Journal, and Google Scholar. Full-text original, descriptive, and analytical studies were collated. Data from retrieved articles were collaboratively reviewed, tabulated, and synthesized. Clinical features, diagnosis, and treatment outcomes were discussed. RESULTS:: A total of 31 articles and 33 patients found to have symptomatic VALFs were included. The mean age of patients was 52 years, 17 (53%) of whom were females. Tortuosity was more apparent on the left, with C4-C5 and C5-C6 (28%) being the most common levels affected. Neck (13%) and shoulder pain (26%) were the most common left- and right-sided presenting symptoms. In the 31 treated patients, 71% (n = 22) underwent surgery, whereas the remaining 29% (n = 9) were treated conservatively. There was complete resolution of symptoms in 54% of patients who underwent surgery and in 75% of patients who were treated conservatively. CONCLUSION:: Vertebral artery loops are understudied yet clinically significant causes of radiculopathy. Believed to arise from various etiologies, it can be tricky to diagnose and manage, necessitating a high index of suspicion and prompt clinical recognition. When conservative management fails, a patient-tailored surgical approach may provide the most direct decompression with the least associated surgical risks.
SN - 2834-4383
ER -