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Eur Spine J. 2017 Jan;26(1):78-84. doi: 10.1007/s00586-016-4660-8. Epub 2016 Jun 24.

The modified Japanese Orthopaedic Association scale: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy.

Author information

1
Division of Neurosurgery and Spinal Program, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst St. Suite 4WW-449, Toronto, ON, M5T 2S8, Canada.
2
Department of Health Services, University of Washington, Seattle, WA, USA.
3
Department of Neurosurgery, University of Kansas, Kansas City, KS, USA.
4
Department of Neurosurgery, University Hospital Catania, Catania, Italy.
5
Department of Neurosurgery, Nijmegen Medical Centre, Radboud University, Nijmegen, The Netherlands.
6
Department of Orthopaedics, Southwest Hospital, Third Military Medical University, Chongqing, People's Republic of China.
7
Department of Neurosurgery, Ege University Faculty of Medicine, Izmir, Turkey.
8
Department of Orthopaedic Surgery, Sidney Kimmel Medical Center at Thomas Jefferson University, Philadelphia, PA, USA.
9
Division of Neurosurgery and Spinal Program, Department of Surgery, Toronto Western Hospital, University of Toronto, 399 Bathurst St. Suite 4WW-449, Toronto, ON, M5T 2S8, Canada. michael.fehlings@uhn.ca.

Abstract

PURPOSE:

We aimed to determine cut-offs between mild, moderate and severe myelopathy on the modified Japanese Orthopedic Association (mJOA) score.

METHODS:

Between December 2005 and January 2011, 757 patients with clinically diagnosed DCM were enrolled in the prospective AOSpine North America (n = 278) or International (n = 479) study at 26 sites. Functional status and quality of life were evaluated at baseline using a variety of outcome measures. Using the Nurick score as an anchor, receiver operating curve (ROC) analysis was conducted to determine cut-offs between mild, moderate and severe disease. The validity of the identified cut-offs was evaluated by examining whether patients in different severity groups differed in terms of impairment, disability, quality of life and number of signs and symptoms.

RESULTS:

A mJOA of 14 was determined to be the cut-off between mild and moderate myelopathy and a mJOA of 11 was the cut-off score between moderate and severe disease. Patients in the severe myelopathy group (n = 254) had significantly reduced quality of life and functional status and a greater number of signs and symptoms compared to patients classified as mild (n = 190) or moderate (n = 296).

CONCLUSIONS:

Mild myelopathy can be defined as mJOA from 15 to 17, moderate as mJOA from 12 to 14 and severe as mJOA from 0 to 11. These categories should be adopted worldwide to standardize clinical assessment of DCM.

KEYWORDS:

Defining disease severity; Degenerative cervical myelopathy; Functional impairment; Measurement; Modified Japanese Orthopaedic Association scale

PMID:
27342612
DOI:
10.1007/s00586-016-4660-8
[Indexed for MEDLINE]

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