Local tortuosity and elongation of a vertebral artery can cause pressure erosion of the adjacent vertebral body and widening of the intervertebral fonamen.

In a study of autopsy specimens, four of 21 specimens were reported to have a tortuous vertebral artery with adjacent bone erosions. However, in clinical practice this is an unusual finding; only isolated case reports have been published. This suggests that the presence of a tortuous vertebral artery may go undetected because ofthe lack of symptoms. However, some patients do have symptoms, such as pain in the neck or cervicooccipital region, radicular pain, or migrainous headache.

Conventional radiognaphs can show enlargement of an intervertebral foramen and erosion of the adjacent vertebral body and pedicle.

Typically, erosion of the vertebra is located eccentrically and involves the posterior or lateral aspect of the body.

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Jian FZ, Santoro A, Wang XW, Passacantili E, Seferi A, Liu SS. A vertebral artery tortuous course below the posterior arch of the atlas (without passing through the transverse foramen). Anatomical report and clinical significance. J Neurosurg Sci. 2003 Dec;47(4):183-7. PMID: 14978471.