Abstract
BACKGROUND: Posterior endoscopic cervical discectomy (PECD) is a minimally invasive procedure with no published reported case of intraoperative vertebral artery injury (VAI) to date. OBSERVATIONS: This report describes a case of VAI during PECD managed with emergency extension of the incision for tamponade hemostasis, followed by endovascular intervention to restore vascular integrity and spinal canal decompression subsequently, resulting in a satisfactory recovery for the patient. LESSONS: PECD carries the risk of intraoperative VAI. Extending the incision for hemostasis, endovascular intervention for revascularization, and spine lamina decompression help prevent three critical complications: hemorrhagic shock, posterior circulation ischemia, and spinal cord injury. https://thejns.org/doi/10.3171/CASE24809.