Analysis of five specific scores for cervical spondylogenic myelopathy

Abstract

The ability to compare various results that measure clinical deficits and outcome is a necessity for successful worldwide discussion about cervical spondylogenic myelopathy (CSM) and its treatment. There is hardly any information in literature how to value and compare outcome assessed by different scores. In a retrospective study we objectively evaluated the Nurick-score, Japanese-orthopaedic-association-score (JOA-Score), Cooper-myelopathyscale (CMS), Prolo-score and European-myelopathy-score (EMS) using the data of 43 patients, all of whom showed clinical and morphological signs of CSM and underwent operative decompression. The scores were assessed pre-and postoperatively. The correlation between the scoreresults, anamnesis, clinical and diagnostic data was investigated. All the scores show a statistically significant correlation and measure postoperative improvement. With exception of the Prolo-score all scores reflect clinical deficits of CSM. The Prolo-score rates the severity of CSM on the state of the economic situation above clinical symptoms. The main differences of the scores are shown in the number of patients showing postoperative improvement, varying between 33% (Nurick-score) and 81% (JOA-score). The recovery-rates, as a measure of the cumulative improvement of all the symptoms, show less variation (23-37%). The differences of the recovery-rate were only statistically significant between JOA-score, Nurick-score and EMS (P \ 0.05), whereas all the other scores showed no significant differences. To assess the postoperative successes, the evaluation of the recovery-rate is essential. There is no significant difference in the recovery-rate amongst the majority of the scores, which allows a good comparison of the results from different studies. Nevertheless, it is always important to differentiate the therapy results of CSM published worldwide.

Comparison of Nurick grading system and modified Japanese Orthopaedic Association scoring system in evaluation of patients with cervical spondylotic myelopathy

“…Interestingly, in our study, the variation in percentage of patients who showed an improvement in the Nurick grade, tmJOA and llmJOA scores was less, ranging from 78.5 to 94.6% for llmJOA and tmJOA scores, respectively, with the percentage of patients determined to have improved their Nurick grade being in between at 83.8%. Although Vitztum et al [12] found a significant difference in the mean postoperative recovery rates assessed by the Nurick grade (23%) and JOA scoring system (37%), the variation was less than that noted for the percentage of patients showing improvement in the different functional scales. Hence, they concluded that to enable comparison across studies that have used CSM specific functional scales, it is more appropriate to report the mean recovery rate rather than the proportion of patients showing an improvement in the functional scores.…”

“…These two patients who had improved from Nurick grade 1 to 0 had no dysfunction on llmJOA preoperatively (score of 7). [12]. In a retrospective study of 43 patients with CSM who underwent anterior decompression, Vitztum et al [12] showed that there was good correlation between the preoperative and postoperative scores using the Nurick scale and JOA scoring system.…”

“…A number of scales are available to assess functional disability in patients with cervical spondylotic myelopathy (CSM) [4,[8][9][10][11][12]. The two commonly used scales are the Nurick grade and modified Japanese Orthopaedic association (mJOA) scoring system (Tables 1, 2).…”

“…On the other hand, if the two instruments complement each other then it would be justified to utilize both of them in a given patient. Only few studies have compared Nurick grading and mJOA score in evaluating functional disability and outcome in patients with CSM [12]. Even these have evaluated the correlation in a small number of patients or in patients undergoing different types of decompressive surgery.…”

Long-term follow-up results of the Cloward procedure for cervical spondylotic myelopathy

“…However, few validated evaluation tools were available for CSM when the first patients evaluated in this series were treated. Moreover, the choice to use the recovery rate to evaluate the improvement obtained with surgery rather than the simple difference between preoperative and postoperative scores, enabled us to decrease the potential discrepancy between the Nurick score recorded in this study and the assessment that can be obtained using more recent validated tools [31]. Despite the above limitations, this study provides useful information on the long-term followup of patients undergoing the Cloward procedure, with important methodological strengths.…”