case_images: PMC8325584_01
case_images: T2 images of the patient being presented. Midsagittal image demonstrates multilevel disc degeneration (a). Far right lateral sagittal image demonstrates anterior course of the right vertebral artery with entry into transverse foramen at C4 (white arrows) (b). Axial T2 images at the level of the C45 disc (c) and the uncovertebral joints (d) demonstrate central and bilateral neuroforaminal stenosis. Note the anterior position of the RVA (white arrow) at the C45 disc level (c). U: uncinate process.
case_images: CRIOR2021-8105298.001.jpg
case_images: PMC8325584_01_CRIOR2021-8105298.001.jpg
case_images: fig1
case_images: A cervical MRI revealed multilevel degenerative changes throughout the cervical spine (Figure 1).
case_images: Axial MEDIC GRE of the patient being presented. The right-VA (RVA) courses anteriorly outside of the transverse foramen at C5 as compared to the left-VA (LVA) within the foramen (a). The RVA courses posteriorly to enter the transverse foramen at C4. Note the proximity of the RVA to the uncinate process (U) (b). At C4, both VA reside in the transverse foramina (RVA: white arrow; U: uncinate process; LVA: black arrow) (c).
case_images: CRIOR2021-8105298.002.jpg
case_images: PMC8325584_01_CRIOR2021-8105298.002.jpg
case_images: fig2
case_images: Once in the C4 transverse foramen, the right VA resumed its typical course cranially, through the transverse foramina at C4 to C2 (Figure 2(c)).
case_images: An anterior view of the cervical spine C7 to C1, with the RVA variant coursing outside of the transverse foramen, entering at C4. The normal course of the LVA is seen on the opposite side for reference.
case_images: CRIOR2021-8105298.003.jpg
case_images: PMC8325584_01_CRIOR2021-8105298.003.jpg
case_images: fig3
case_images: A pictorial description of the C4 VA high entry anomaly is depicted in Figure 3.
case_images: Lateral radiograph obtained six weeks postoperatively. Lateral radiograph reveals status-postanterior cervical discectomy with placement of allograft spacer and anterior cervical plate with variable angle screws.
case_images: CRIOR2021-8105298.004.jpg
case_images: PMC8325584_01_CRIOR2021-8105298.004.jpg
case_images: fig4
case_images: TN) was placed (Figure 4). The patient had a successful postoperative course with no evidence of any vascular damage after surgery and at 1-year follow-up.