A Rare C7 Nerve Root Variant Encountered During Unilateral Biportal Endoscopic Posterior Cervical Foraminotomy: Caudomedial Takeoff and Craniolateral Course

Cervical nerve root anatomy is generally predictable and forms the basis of posterior cervical foraminotomy (PCF). However, rare anatomical variants may alter the expected nerve root trajectory. This report describes 2 cases of a rare C7 nerve root variant encountered during unilateral biportal endoscopic PCF (UBE PCF). Two patients with cervical radiculopathy underwent UBE PCF that included decompression for C6–7 foraminal stenosis. Intraoperative endoscopic findings revealed an atypical C7 nerve root trajectory characterized by a caudomedial takeoff and craniolateral course. Endoscopic visualization enabled accurate identification of the nerve root origin and trajectory, allowing adequate decompression. Both patients had marked postoperative improvement in radiating arm pain. A caudomedial origin and craniolateral course of the C7 nerve root represent a rare but clinically relevant anatomical variant during PCF. UBE PCF facilitates precise identification and safe decompression of this variant through clear endoscopic visualization.