The European Myelopathy Score

Abstract

In 1975 the Japanese Orthopedic 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: (a) the upper motor neuron with signs of spasticity as well as bladder and bowel malfunction, (b) the lower motor neuron with impairment of hand function, (c) the posterior roots with upper limb radicular deficits and paresthesias, and (d) 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.