LAUSR

The authors present an interesting case and well written description of tortuous vertebral artery (VA) compression of the C6 nerve root concurrent with cervical spondylosis [1]. The authors raise very valid points in the diagnosis and workup of nerve root compression induced by vertebral artery loops. It is likely that this is underreported as a high degree of suspicion is required along with significant MRI diagnostic abilities. It is quite possible that many radiologists are not aware of the potential for VA-induced root compression and hence underreport this finding or simply label this as a norm variant. The authors chose a posterior approach with facetectomy and interposition of a Teflon sponge. An alternative may have been an anterior lateral approach with transposition of the VA and anterior foraminotomy as described by Cornelius et al. [2], which may have avoided the need for fusion. The disadvantage of this approach of course is the lesser familiarity to spinal surgeons. Furthermore, transposing the VA is technically more demanding due to the necessary detethering of the VA in the foramen to allow transposition [3]. The authors are commended for having carefully diagnosed this uncommon condition and conducted well-considered and thorough surgery.