Practice Tools: Degenerative Cervical Myelopathy – The Modified JOA Questionnaire

Review written by: James Demetrious, DC, DABCO

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Degenerative cervical myelopathy (DCM) is a complex and disabling condition. The determination for surgical intervention versus non-surgical care requires careful consideration. Standardized diagnostic protocols are not well established that can provide prognostic insight. Despite the unsettled science, we must attempt to identify and stage appropriate care modalities.


The decision to utilize non-operative versus surgical care is discussed in a systematic review by Rhee et al. ( In their article, the authors refer to the modified Japanese Orthopedic Association Scale (mJOA).

Practical Tools

The mJOA Questionnaire is easy to utilize and can help decision making, track patients’ progress and recovery. Patients’ complete questions related to upper and lower extremity motor function, sensation, and sphincteric function. Answers are scored and the severity of myelopathy is rated:

  • Normal (mJOA of 18)
  • Mild Myelopathy (mJOA from 15-17)
  • Moderate Myelopathy (mJOA from 12-14)
  • Severe Myelopathy (mJOA from 1-11)


Rhee et al. report:

  • The results of this update indicate that non-operative management results in similar outcomes as surgical treatment in patients with a mJOA 13, single-level myelopathy, and intramedullary signal change on T2-weighted MRI.
  • However, we believe that these patients, if managed non-operatively, should be followed closely and monitored for neurological deterioration.
  • It is important that clinicians inform their patients of the possibility of disease progression and educate them on future relevant symptoms.
  • Furthermore, patients managed non-operatively for DCM have higher rates of subsequent hospitalization for spinal cord injury than those treated surgically.
  • This increased risk should be factored into clinical decision making and included in discussions with patients when weighing the risks and benefits of operative versus nonoperative care.

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