{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:07:22Z","timestamp":1772827642473,"version":"3.50.1"},"reference-count":62,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,12]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Posterior cervical foraminotomy (PCF) is an established motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy. However, concerns remain regarding the efficacy of PCF in patients with vertically narrow foramina, where decompression in the craniocaudal direction is limited. This study was conducted to evaluate the impact of narrow foraminal height (FH; &lt; 6 mm) on clinical and radiographic outcomes following PCF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This retrospective cohort study reviewed the records of 82 patients who underwent PCF with \u2265 2 years of follow-up. Patients were categorized into narrow FH (n = 30) and high FH (n = 52) groups. Clinical outcomes included visual analog scale (VAS) scores for neck and arm pain, the Neck Disability Index (NDI), and the achievement of the minimal clinically important difference (MCID). Radiographic parameters and revision surgery rates were also assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The narrow FH group had a significantly higher rate of revision surgeries (13.3% vs 0%, p = 0.016). Although both groups experienced significant pain reduction, only the high FH group showed significant improvement in NDI scores at 3 months. The proportion of patients achieving MCID for arm pain was significantly lower in the narrow FH group (p = 0.021). Postoperative cervical range of motion was also more restricted in the narrow FH group. FH did not significantly change postoperatively in either group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Narrow FH adversely affects clinical outcomes and increases the risk of revision surgery following PCF. Surgeons should consider alternative approaches, such as ACDF, for patients with preoperative FH &lt; 6 mm.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.7.spine25502","type":"journal-article","created":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T17:12:21Z","timestamp":1770829941000},"page":"340-348","source":"Crossref","is-referenced-by-count":0,"title":["Does narrow foraminal height adversely affect outcomes of posterior cervical foraminotomy for cervical radiculopathy?"],"prefix":"10.3171","volume":"44","author":[{"given":"Seungmin","family":"Lee","sequence":"first","affiliation":[{"name":"Ewha Women\u2019s University, College of Medicine, Seoul; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chang Ju","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Hwan","family":"Cho","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sehan","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Clin Spine Surg","first-page":"149","article-title":"Surgical treatment of single level cervical radiculopathy: a comparison of anterior cervical decompression and fusion (ACDF) versus cervical disk arthroplasty (CDA) versus posterior cervical foraminotomy (PCF)","volume":"35","author":"Padhye K","year":"2022","unstructured":"Padhye K, Shultz P, Alcala C,  Surgical treatment of single level cervical radiculopathy: a comparison of anterior cervical decompression and fusion (ACDF) versus cervical disk arthroplasty (CDA) versus posterior cervical foraminotomy (PCF). Clin Spine Surg. 2022;35(4):149\u2013154."},{"issue":"1","key":"b2","series-title":"Asian Spine J","first-page":"121","article-title":"Cervical spondylotic myelopathy and radiculopathy: a stepwise approach and comparative analysis of surgical outcomes: a narrative review of recent literature","volume":"19","author":"Kim MW","year":"2025","unstructured":"Kim MW, Park YS, Kang CN, Choi SH. Cervical spondylotic myelopathy and radiculopathy: a stepwise approach and comparative analysis of surgical outcomes: a narrative review of recent literature. Asian Spine J. 2025;19(1):121\u2013132."},{"issue":"1","key":"b3","series-title":"J Orthop Surg Res","first-page":"202","article-title":"Anterior cervical discectomy and fusion versus posterior cervical foraminotomy for the treatment of single-level unilateral cervical radiculopathy: a meta-analysis","volume":"15","author":"Fang W","year":"2020","unstructured":"Fang W, Huang L, Feng F,  Anterior cervical discectomy and fusion versus posterior cervical foraminotomy for the treatment of single-level unilateral cervical radiculopathy: a meta-analysis. J Orthop Surg Res. 2020;15(1):202."},{"issue":"12","key":"b4","series-title":"Spine J","first-page":"2253","article-title":"Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy","volume":"24","author":"Park S","year":"2024","unstructured":"Park S, Jeong G, Hwang CJ, Cho JH, Lee DH. Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy. Spine J. 2024;24(12):2253\u20132263."},{"issue":"4","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"324","article-title":"Comparing mid-term outcomes between ACDF and minimally invasive posterior cervical foraminotomy in the treatment of cervical radiculopathy","volume":"47","author":"Emami A","year":"2022","unstructured":"Emami A, Coban D, Changoor S,  Comparing mid-term outcomes between ACDF and minimally invasive posterior cervical foraminotomy in the treatment of cervical radiculopathy. Spine (Phila Pa 1976). 2022;47(4):324\u2013330."},{"issue":"1","key":"b6","series-title":"JAMA Neurol","first-page":"40","article-title":"Noninferiority of posterior cervical foraminotomy vs anterior cervical discectomy with fusion for procedural success and reduction in arm pain among patients with cervical radiculopathy at 1 year: the FACET randomized clinical trial","volume":"80","author":"Broekema AEH","year":"2023","unstructured":"Broekema AEH, Sim\u00f5es de Souza NF, Soer R,  Noninferiority of posterior cervical foraminotomy vs anterior cervical discectomy with fusion for procedural success and reduction in arm pain among patients with cervical radiculopathy at 1 year: the FACET randomized clinical trial. JAMA Neurol. 2023;80(1):40\u201348."},{"issue":"6","key":"b7","series-title":"Asian Spine J","first-page":"995","article-title":"Cervical radiculopathy: focus on factors for better surgical outcomes and operative techniques","volume":"16","author":"Kang KC","year":"2022","unstructured":"Kang KC, Jang TS, Jung CH. Cervical radiculopathy: focus on factors for better surgical outcomes and operative techniques. Asian Spine J. 2022;16(6):995\u20131012."},{"key":"b8","first-page":"e485","article-title":"Does the neck pain, function, or range of motion differ after anterior cervical fusion, cervical disc replacement, and posterior cervical foraminotomy?","volume":"129","author":"Lin GX","year":"2019","unstructured":"Lin GX, Rui G, Sharma S, Kotheeranurak V, Suen TK, Kim JS. Does the neck pain, function, or range of motion differ after anterior cervical fusion, cervical disc replacement, and posterior cervical foraminotomy? 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Spine (Phila Pa 1976). 2023;48(18):1266\u20131271."},{"issue":"3","key":"b10","series-title":"J Neurosurg Spine","first-page":"344","article-title":"Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register","volume":"32","author":"MacDowall A","year":"2020","unstructured":"MacDowall A, Heary RF, Holy M, Lindhagen L, Olerud C. Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register. J Neurosurg Spine. 2020;32(3):344\u2013352."},{"issue":"8","key":"b11","series-title":"Global Spine J","first-page":"2357","article-title":"Foraminal restenosis after posterior cervical foraminotomy for the treatment of cervical radiculopathy","volume":"13","author":"Lee DH","year":"2023","unstructured":"Lee DH, Lee HJ, Cho JH,  Foraminal restenosis after posterior cervical foraminotomy for the treatment of cervical radiculopathy. Global Spine J. 2023;13(8):2357\u20132366."},{"issue":"2","key":"b12","series-title":"Am J Phys Med Rehabil","first-page":"159","article-title":"Ultrasonographic cross-sectional area of spinal nerve roots in cervical radiculopathy: a pilot study","volume":"94","author":"Kim E","year":"2015","unstructured":"Kim E, Yoon JS, Kang HJ. Ultrasonographic cross-sectional area of spinal nerve roots in cervical radiculopathy: a pilot study. Am J Phys Med Rehabil. 2015;94(2):159\u2013164."},{"issue":"3","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"286","article-title":"The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine","volume":"25","author":"Tanaka N","year":"2000","unstructured":"Tanaka N, Fujimoto Y, An HS, Ikuta Y, Yasuda M. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine (Phila Pa 1976). 2000;25(3):286\u2013291."},{"issue":"Suppl 15","key":"b14","series-title":"Surg Neurol Int","first-page":"S536","article-title":"Cervical laminoforaminotomy for radiculopathy: symptomatic and functional outcomes in a large cohort with long-term follow-up","volume":"5","author":"Church EW","year":"2014","unstructured":"Church EW, Halpern CH, Faught RW,  Cervical laminoforaminotomy for radiculopathy: symptomatic and functional outcomes in a large cohort with long-term follow-up. Surg Neurol Int. 2014;5(Suppl 15):S536\u2013S543."},{"issue":"1","key":"b15","series-title":"BMC Musculoskelet Disord","first-page":"290","article-title":"A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and\/or lateral spinal stenosis: a clinical retrospective study","volume":"21","author":"Tong Y","year":"2020","unstructured":"Tong Y, Huang Z, Hu C,  A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and\/or lateral spinal stenosis: a clinical retrospective study. BMC Musculoskelet Disord. 2020;21(1):290."},{"issue":"6","key":"b16","series-title":"Spine J","first-page":"469","article-title":"Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion","volume":"10","author":"Carreon LY","year":"2010","unstructured":"Carreon LY, Glassman SD, Campbell MJ, Anderson PA. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J. 2010;10(6):469\u2013474."},{"key":"b17","first-page":"e555","article-title":"Segmental height decrease adversely affects foraminal height and cervical lordosis, but not clinical outcome after anterior cervical discectomy and fusion using allografts","volume":"154","author":"Yang JJ","year":"2021","unstructured":"Yang JJ, Park S, Kim HJ, Yoon JY. Segmental height decrease adversely affects foraminal height and cervical lordosis, but not clinical outcome after anterior cervical discectomy and fusion using allografts. World Neurosurg.2021;154:e555\u2013e565."},{"key":"b18","series-title":"Front Surg","first-page":"950707","article-title":"Analysis between preoperative cervical radiographic parameters represented by the K-line tilt and the short-term prognosis of laminoplasty for posterior longitudinal ligament ossification: a retrospective study","volume":"9","author":"Wei B","year":"2022","unstructured":"Wei B, Liu W, Wu H. Analysis between preoperative cervical radiographic parameters represented by the K-line tilt and the short-term prognosis of laminoplasty for posterior longitudinal ligament ossification: a retrospective study. Front Surg. 2022;9:950707."},{"issue":"4","key":"b19","series-title":"Spine J","first-page":"540","article-title":"Dimensional changes of the neuroforamina in subaxial cervical spine during in vivo dynamic flexion-extension","volume":"16","author":"Mao H","year":"2016","unstructured":"Mao H, Driscoll SJ, Li JS, Li G, Wood KB, Cha TD. Dimensional changes of the neuroforamina in subaxial cervical spine during in vivo dynamic flexion-extension. Spine J. 2016;16(4):540\u2013546."},{"issue":"24","key":"b20","series-title":"Spine (Phila Pa 1976)","first-page":"2821","article-title":"Morphologic changes in the cervical neural foramen due to flexion and extension: in vivo imaging study","volume":"29","author":"Kitagawa T","year":"2004","unstructured":"Kitagawa T, Fujiwara A, Kobayashi N, Saiki K, Tamai K, Saotome K. Morphologic changes in the cervical neural foramen due to flexion and extension: in vivo imaging study. Spine (Phila Pa 1976). 2004;29(24):2821\u20132825."},{"key":"b21","series-title":"J Clin Neurosci","first-page":"99","article-title":"Quantitative radiographic analysis of foraminal re-stenosis after posterior cervical foraminotomy with laminoplasty","volume":"67","author":"Mizouchi T","year":"2019","unstructured":"Mizouchi T, Watanabe K, Izumi T,  Quantitative radiographic analysis of foraminal re-stenosis after posterior cervical foraminotomy with laminoplasty. 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World Neurosurg.2022;165:e423\u2013e431."},{"issue":"6","key":"b24","series-title":"Spine J","first-page":"629","article-title":"Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression","volume":"4","author":"Shen FH","year":"2004","unstructured":"Shen FH, Samartzis D, Khanna N, Goldberg EJ, An HS. Comparison of clinical and radiographic outcome in instrumented anterior cervical discectomy and fusion with or without direct uncovertebral joint decompression. Spine J. 2004;4(6):629\u2013635."},{"issue":"6","key":"b25","series-title":"Neurosurg Rev","first-page":"3609","article-title":"Minimally invasive posterior cervical foraminotomy versus anterior cervical discectomy and fusion for cervical radiculopathy: a meta-analysis","volume":"45","author":"Zou T","year":"2022","unstructured":"Zou T, Wang PC, Chen H, Feng XM, Sun HH. Minimally invasive posterior cervical foraminotomy versus anterior cervical discectomy and fusion for cervical radiculopathy: a meta-analysis. Neurosurg Rev. 2022;45(6):3609\u20133618."},{"issue":"1","key":"b26","series-title":"Asian Spine J","first-page":"32","article-title":"Surgical outcomes of full endoscopic posterior cervical foraminotomy for proximal cervical spondylotic amyotrophy","volume":"18","author":"Lee D","year":"2024","unstructured":"Lee D, Ohmori K, Yoneyama R, Endo T, Endo Y. Surgical outcomes of full endoscopic posterior cervical foraminotomy for proximal cervical spondylotic amyotrophy. Asian Spine J. 2024;18(1):32\u201341."},{"issue":"4","key":"b27","series-title":"J Orthop Sci","first-page":"758","article-title":"Limitations of minimally invasive posterior cervical foraminotomy-a decompression method of posteriorly shifting the nerve root-in cases of large anterior osteophytes in cervical radiculopathy: a retrospective multicenter cohort study","volume":"28","author":"Oshina M","year":"2023","unstructured":"Oshina M, Tani S, Yamada T,  Limitations of minimally invasive posterior cervical foraminotomy-a decompression method of posteriorly shifting the nerve root-in cases of large anterior osteophytes in cervical radiculopathy: a retrospective multicenter cohort study. J Orthop Sci. 2023;28(4):758\u2013764."},{"key":"b28","series-title":"Spine J","first-page":"S1529","article-title":"Morphometric analysis of cervical neuroforaminal dimensions from C2-T1 using computed tomography of 1,000 patients","author":"Razzouk J","year":"2024","unstructured":"Razzouk J, Case T, Vyhmeister E,  Morphometric analysis of cervical neuroforaminal dimensions from C2-T1 using computed tomography of 1,000 patients. Spine J. 2024:S1529."},{"issue":"1","key":"b29","series-title":"Sci Rep","first-page":"16011","article-title":"Utility of oblique sagittal reformatted and three-dimensional surface reconstruction computed tomography in foraminal stenosis decompression","volume":"8","author":"Oshina M","year":"2018","unstructured":"Oshina M, Oshima Y, Tanaka S,  Utility of oblique sagittal reformatted and three-dimensional surface reconstruction computed tomography in foraminal stenosis decompression. 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Evaluation of dynamic foraminal stenosis with positional mri in patients with c6 radiculopathy-mimicking pain: a prospective radiologic cohort study. Biomed Res Int. 2022;2022:1385387."},{"issue":"4","key":"b1","series-title":"Clin Spine Surg","first-page":"149","article-title":"Surgical treatment of single level cervical radiculopathy: a comparison of anterior cervical decompression and fusion (ACDF) versus cervical disk arthroplasty (CDA) versus posterior cervical foraminotomy (PCF)","volume":"35","author":"Padhye K","year":"2022","unstructured":"Padhye K, Shultz P, Alcala C,  Surgical treatment of single level cervical radiculopathy: a comparison of anterior cervical decompression and fusion (ACDF) versus cervical disk arthroplasty (CDA) versus posterior cervical foraminotomy (PCF). 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Asian Spine J. 2025;19(1):121\u2013132."},{"issue":"1","key":"b3","series-title":"J Orthop Surg Res","first-page":"202","article-title":"Anterior cervical discectomy and fusion versus posterior cervical foraminotomy for the treatment of single-level unilateral cervical radiculopathy: a meta-analysis","volume":"15","author":"Fang W","year":"2020","unstructured":"Fang W, Huang L, Feng F,  Anterior cervical discectomy and fusion versus posterior cervical foraminotomy for the treatment of single-level unilateral cervical radiculopathy: a meta-analysis. J Orthop Surg Res. 2020;15(1):202."},{"issue":"12","key":"b4","series-title":"Spine J","first-page":"2253","article-title":"Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy","volume":"24","author":"Park S","year":"2024","unstructured":"Park S, Jeong G, Hwang CJ, Cho JH, Lee DH. Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy. Spine J. 2024;24(12):2253\u20132263."},{"issue":"4","key":"b5","series-title":"Spine (Phila Pa 1976)","first-page":"324","article-title":"Comparing mid-term outcomes between ACDF and minimally invasive posterior cervical foraminotomy in the treatment of cervical radiculopathy","volume":"47","author":"Emami A","year":"2022","unstructured":"Emami A, Coban D, Changoor S,  Comparing mid-term outcomes between ACDF and minimally invasive posterior cervical foraminotomy in the treatment of cervical radiculopathy. 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World Neurosurg.2019;129:e485\u2013e493."},{"issue":"18","key":"b9","series-title":"Spine (Phila Pa 1976)","first-page":"1266","article-title":"Single-level anterior cervical discectomy and fusion results in lower five-year revisions than posterior cervical foraminotomy in a large national cohort","volume":"48","author":"Jayaram RH","year":"2023","unstructured":"Jayaram RH, Joo PY, Gouzoulis MJ, Ratnasamy PP, Caruana DL, Grauer JN. Single-level anterior cervical discectomy and fusion results in lower five-year revisions than posterior cervical foraminotomy in a large national cohort. Spine (Phila Pa 1976). 2023;48(18):1266\u20131271."},{"issue":"3","key":"b10","series-title":"J Neurosurg Spine","first-page":"344","article-title":"Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register","volume":"32","author":"MacDowall A","year":"2020","unstructured":"MacDowall A, Heary RF, Holy M, Lindhagen L, Olerud C. Posterior foraminotomy versus anterior decompression and fusion in patients with cervical degenerative disc disease with radiculopathy: up to 5 years of outcome from the national Swedish Spine Register. J Neurosurg Spine. 2020;32(3):344\u2013352."},{"issue":"8","key":"b11","series-title":"Global Spine J","first-page":"2357","article-title":"Foraminal restenosis after posterior cervical foraminotomy for the treatment of cervical radiculopathy","volume":"13","author":"Lee DH","year":"2023","unstructured":"Lee DH, Lee HJ, Cho JH,  Foraminal restenosis after posterior cervical foraminotomy for the treatment of cervical radiculopathy. Global Spine J. 2023;13(8):2357\u20132366."},{"issue":"2","key":"b12","series-title":"Am J Phys Med Rehabil","first-page":"159","article-title":"Ultrasonographic cross-sectional area of spinal nerve roots in cervical radiculopathy: a pilot study","volume":"94","author":"Kim E","year":"2015","unstructured":"Kim E, Yoon JS, Kang HJ. Ultrasonographic cross-sectional area of spinal nerve roots in cervical radiculopathy: a pilot study. Am J Phys Med Rehabil. 2015;94(2):159\u2013164."},{"issue":"3","key":"b13","series-title":"Spine (Phila Pa 1976)","first-page":"286","article-title":"The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine","volume":"25","author":"Tanaka N","year":"2000","unstructured":"Tanaka N, Fujimoto Y, An HS, Ikuta Y, Yasuda M. The anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine (Phila Pa 1976). 2000;25(3):286\u2013291."},{"issue":"Suppl 15","key":"b14","series-title":"Surg Neurol Int","first-page":"S536","article-title":"Cervical laminoforaminotomy for radiculopathy: symptomatic and functional outcomes in a large cohort with long-term follow-up","volume":"5","author":"Church EW","year":"2014","unstructured":"Church EW, Halpern CH, Faught RW,  Cervical laminoforaminotomy for radiculopathy: symptomatic and functional outcomes in a large cohort with long-term follow-up. Surg Neurol Int. 2014;5(Suppl 15):S536\u2013S543."},{"issue":"1","key":"b15","series-title":"BMC Musculoskelet Disord","first-page":"290","article-title":"A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and\/or lateral spinal stenosis: a clinical retrospective study","volume":"21","author":"Tong Y","year":"2020","unstructured":"Tong Y, Huang Z, Hu C,  A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and\/or lateral spinal stenosis: a clinical retrospective study. 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