C3/4 Stenosis and Lower Limb Functional Impairment in Cervical Spondylotic Myelopathy: A Retrospective Exploratory Study

Cervical spondylotic myelopathy (CSM) is a common clinical syndrome caused by degenerative changes of the cervical spine and frequently presents with lower extremity dysfunction. However, the relationship between specific cervical levels and lower extremity functional impairment remains unclear. This retrospective single-center study investigated the association between C3/4 stenosis and lower extremity dysfunction in patients with CSM. Twenty-four patients who underwent surgical treatment between April 2024 and June 2025 were included after excluding those with comorbidities affecting lower extremity function. C3/4 stenosis was defined as an anteroposterior-to-transverse diameter ratio of less than 0.4 on axial T2-weighted magnetic resonance imaging (MRI). Clinical severity was evaluated using the Japanese Orthopaedic Association (JOA) score and the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOA-CMEQ). Patients with C3/4 stenosis were significantly older and demonstrated significantly worse lower-extremity motor and sensory scores on the JOA scale, as well as poorer lower-extremity function scores on the JOA-CMEQ. After adjustment for age, C3/4 stenosis was associated with lower extremity sensory dysfunction and patient-reported lower extremity disability. These findings suggest that patients with C3/4 stenosis demonstrated worse lower extremity-related functional impairment in this retrospective exploratory cohort, possibly reflecting the anatomical organization of sensory pathways within the posterior column at upper cervical levels. However, the independent contribution of C3/4 pathology could not be definitively determined from the present analysis.