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

Background: Cervical radiculopathy from vertebral artery loop formation (VALF) is rare; this case highlights endoscopic management after conservative failure. Methods: Clinical case about VALF treated by posterior decompression was reported. And literature review was conducted to identify studies investigating surgical treatments for a VALF. Case description: A 69-year-old woman had 4-month right C5 radiculopathy (neck pain, arm radiation, Spurling-positive) due to VALF at C4-5 confirmed by MRI and CT angiography. After failed conservative treatment, full-endoscopic posterior foraminotomy was done; 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 safely resolves VALF-induced radiculopathy, avoiding vascular risks of open approaches.