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

Lindsay Tetreault, Branko Kopjar, Aria Nouri, Paul Arnold, Giuseppe Barbagallo, Ronald Bartels, Zhou Qiang, Anoushka Singh, Mehmet Zileli, Alexander Vaccaro, Michael G. Fehlings

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)78-84
Number of pages7
JournalEuropean Spine Journal
Volume26
Issue number1
DOIs
StatePublished - Jan 1 2017

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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