The Japanese Orthopaedic Association (JOA) has developed a clinical symptom score for lumbar disc herniation and for lumbar spinal canal stenosis . This can help determine the degree of improvement following surgical intervention.
The score range −2 to 16.
Parameters in the score:
(1) subjective symptoms (9 points): low back pain leg pain and/or tingling gait
(2) clinical signs (6 points): straight-leg raising test sensory disturbance motor disturbance
(3) restriction in activities (14 points): turn over while lying standing washing leaning forward sitting about 1 hour lifting or holding a heavy object walking
(4) urinary bladder function (-6 points maximum)
none 3
occasional mild pain 2
frequent mild 1
occasional severe pain 1
frequent pain 0
continuous pain 0
none 3
occasional slight symptoms 2
frequent slight symptoms 1
occasional severe symptoms 1
frequent severe symptoms 0
continuous severe symptoms 0
normal  3 able to walk
500 meters or more although it results in pain tingling and/or muscle weakness 2
unable to walk > 500 meters owing to leg pain tingling and/or muscle weakness 1
unable to walk > 100 meters owing to leg pain tingling and/or muscle weakness 0
normal (> 70°) 2
30 to 70° 1
< 30° 0
none 2
slight disturbance (not subjective) 1
marked disturbance 0
normal (Grade 5) 2
slight weakness (Grade 4) 1
marked weakness (Grades 0 to 3) 0
no restriction 2
moderate restriction 1
severe restriction 0
no restriction 2
moderate restriction 1
severe restriction 0
no restriction 2
moderate restriction 1
severe restriction 0
no restriction 2
moderate restriction 1
severe restriction 0
no restriction 2
moderate restriction 1
severe restriction 0
no restriction 2
moderate restriction 1
severe restriction 0
no restriction 2
moderate restriction 1
severe restriction 0
normal 0
mild dysuria -3
severe dysuria -6
where: • I used dysfunction in the implementation for urinary bladder function.
total score = SUM(points for all parameters)
Interpretation:
• minimum score: -6
• maximum score: 29
• The higher the score the more normal the patient's overall status.
postoperative improvement in percent = (postoperative score) – (preoperative score) / (29 – (preoperative score) * 100% 1) 2).