====== 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 =====


Criterion	Points

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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
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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
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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
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Getting dressed only with aid	1
 
Getting dressed clumsily and slowly	2

Getting dressed normally	3
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Invalidity due to pain	1

Endurable paraesthesia and pain	2

No paraesthesia and pain	3
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Total score	5–18
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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%