Multiple symptomatic vertebral artery loops treated with posterior cervical fusion

Multiple symptomatic vertebral artery (VA) loops are rare and their management is challenging. A 55-year-old man presented with a 5-year history of frequent episodes of presyncope and mild left C5 radiculopathy that was exacerbated by flexion or extension of his neck. Examination revealed complex left VA loops at C2/3 and C4. The patient underwent posterior cervical fusion which resolved his presyncope and improved his radiculopathy. Posterior cervical fusion is an option for management of patients suffering from symptoms secondary to multiple VA loops.