Vertebral artery stenosis caused by cervical spondylosis is generally caused by compression of the artery by osteophytes arising from an uncinate process. Compression caused by facet joint osteophytes is rarely reported. The paper shows that compression may also occur posteriorly by osteophytes from the facet complex. Careful evaluation of preoperative angiograms and computed tomographic or MRI scans is required to determine whether an anterolateral, posteriorlateral or posterior approach might be more beneficial for decompression.