[Objective] To explore the method of avoiding vertebral artery injury in posterior percutaneous endoscopic cervical discectomy (PPECD) using 3-D CT.[Method] 16 patients with cervical spondylotic radiculopathy (CSR) were randomly selected, including 5 males and 11 females, ranging in age from 40 to 58 years, with an average age of (48.63±5.57) years. Head-neck CT angiography (CTA) begins to be implemented after obtaining patients’ informed consent and signed. Then the DICOM data were imported into MIMICS 16.0 to reconstruct the 3-D CT images of cervical vertebrae and vertebral artery and observe and measure it. At the level of cervical intervertebral space, we measure the distances between the intersection of the vertical line at the inner side of the zygapophysial joint space and inside the inferior margin of the inferior articular process (point O) and the anterior, posterior, inside, outside of margins of vertebral artery, the highest point of the lateral margin of uncinate process and the anterior, posterior, inside, outside of margins of vertebral artery, the most lateral margin of lateral mass and the anterior, posterior, inside, outside of margins of vertebral artery. The front-back diameter and left-right diameters of vertebral artery were measured respectively.[Result] There was no significant difference in the distance between point O, the highest point of the lateral margin of uncinate process, the most lateral margin of lateral mass and vertebral artery at C3/4-C5/6 (P > 0.05). The point O and the lateral margin of the lateral mass were the closest to the vertebral artery at C3/4. The highest point of the lateral margin of the uncinate process was the closest to the vertebral artery at C5/6. The front-back diameter vertebral artery was 3.15±1.46 mm-3.75±0.93 mm and the left-right diameter was 3.18±2.20 mm-4.14±0.96 mm at C2/3-C7/T1, with no significant difference (P>0.05).[Conclusion] The incidence of vertebral artery injury by fenestration and decompression using point O as the marking point in PPECD is low. The sharp surgical instrument slides forward along the lateral margin of the dura mater and the lateral margin of the C7/T1 lateral mass, which may injure the vertebral artery. When clamping or grinding cervical intervertebral disc (or calcification) protruding ventrally to the cervical nerve, the hyperplastic osteophytes of uncinate joint and posterior edge of vertebral, the possibility of disturbing or injuring the vertebral artery deep in the cervical nerve increases, and the location of the vertebral artery should be confirmed at any time.