Endoscopic Decompression of Radiculopathy Caused by Vertebral Artery Loop Formation: Case Report and Literature Review

Background: Cervical radiculopathy due to vertebral artery loop formation (VALF) is rare. This case demonstrates endoscopic posterior foraminotomy after failed conservative treatment. Methods: We report a case of VALF treated by means of uniportal full-endoscopic posterior foraminotomy. A focused narrative literature review identified prior surgical cases of VALF-related cervical radiculopathy. Case description: A 69-year-old woman had a 4-month right C5 radiculopathy (neck pain, arm radiation, Spurling-positive) due to VALF at C4–5, confirmed via MRI and CT angiography. After failed conservative treatment, full-endoscopic posterior foraminotomy was performed; the symptoms resolved at 3 months. Conclusions: Clinicians should be aware that vertebral artery loop formation, although rare, is an important potential cause of cervical radiculopathy. In suspected cases, the vertebral artery should be carefully evaluated with MR or CT angiography to confirm the presence of a loop formation. Full-endoscopic posterior foraminotomy may be technically feasible for carefully selected patients with VALF-related cervical radiculopathy, demonstrating short-term symptom improvement in this case.