title: Rotational vertebral artery insufficiency resulting from cervical spondylosis: case report and review of the literature.
abstract: BACKGROUND
  Four cases of vertebrobasilar insufficiency secondary to osteophyte formation at C5-C6 have been reported in the literature. In this article, we report the fifth such case and discuss the utility of dynamic computed tomographic angiography (CTA) in the management of this disorder.
  
  
  METHODS
  A 55-year-old right-handed man presented for evaluation after syncopal episodes associated with right-head turning. Workup revealed cervical spondylosis with stenosis. The C5-C6 level was significantly affected. Dynamic angiography revealed obstruction of vertebral artery flow with right-head turning secondary to an osteophyte at the foramen transversarium at C5-C6. This patient underwent a C5-C6 anterior cervical discectomy and fusion. He also underwent unroofing of the vertebral artery and drilling of the osteophyte at the foramen transversarium. Postoperative CTAs reveal reconstitution of flow in the vertebral artery with head turning.
  
  
  CONCLUSIONS
  The utility of dynamic 3-dimensional CTA in the management of this disorder avoids the risk of invasive studies.
authors.affiliation: Skull Base and Cerebrovascular Surgery, Division of Neurosurgery, University of Missouri-Columbia, Columbia, MO 65212, USA. ketanbulsara@hotmail.com
authors.forename: Ketan R
authors.initials: KR
authors.lastname: Bulsara
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Velez
authors.forename: Alan
authors.initials: A
authors.lastname: Villavicencio
mesh_terms: D002574:Cervical Vertebrae / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012399:Rotation; D012720:Severity of Illness Index; D013128:Spinal Osteophytosis / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000175:diagnosis / Q000209:etiology*