European myelopathy score

In 1975 the Japanese Orthopaedic Association (JOA) introduced a score for the clinical neurological judgment of cervical myelopathy. In Japan and other Oriental countries this so-called JOA score is especially popular for judging the clinical progression of a disease known as ossification of the posterior longitudinal ligament (OPLL), which is very common in Japan.

Attempts to apply the JOA score to European, i.e. Western, patients have been disappointing because of cultural differences between Orientals and Westerners: the first criterion on the JOA score rates the ability to eat with chopsticks, which would leave most Westerners with a distinct impairment of upper limb function as a sign of cervical myelopathy. In particular, the JOA score does not take into account the four major neural systems, the impairment of which contributes to the clinical picture of cervical myelopathy:

1.- the upper motor neuron with signs of spasticity as well as bladder and bowel malfunction

2.- the lower motor neuron with impairment of hand function

3.- the posterior roots with upper limb radicular deficits and paresthesias

4.- the posterior columns with proprioceptive sensory loss, disturbed coordination, and ataxia. In order to close this gap a European Myelopathy Score was developed which rates these systems in a simple and concise manner.

Criterion Points

Unable to walk, wheelchair 1

Walking on a flat ground only with cane or aid 2

Climbing stairs only with aid 3

Gait clumsy, but no aid necessary 4

Normal walking and climbing stairs 5

Retention, no control over bladder and/or bowel function 1

Bladder and bowel function Inadequate micturition and urinary frequency 2

Normal bladder and bowel function 3

Handwriting and eating with knife and fork impossible 1

Handwriting and eating with knife and fork impaired 2

Handwriting, tying shoe laces or a tie clumsy 3

Normal handwriting 4

Getting dressed only with aid 1

Getting dressed clumsily and slowly 2

Getting dressed normally 3

Invalidity due to pain 1

Endurable paraesthesia and pain 2

No paraesthesia and pain 3

Total score 5–18

The lower the score the more severe the deficits. Normal function: 17 + 18, grade 1: 13–16, grade 2: 9–12, grade 3: 5–8. Weight of the criterion in percentage of 18 points: upper extremity 27.8%, lower extremity 22.2%, coordination 16.7%, paraesthesia/pain 16.0%, bladder and bowel function 16.7%