Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy
Introduction: People with Degenerative Cervical Myelopathy (DCM) often experience diagnostic delay. This could lead to poorer outcomes, including disability. Research question: Does the modified Japanese Orthopaedic Association scale (mJOA) have clinical utility as an early detection tool for possib...
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Elsevier
2024-01-01
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| Series: | Brain and Spine |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772529424001097 |
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| author | Caroline Treanor Conor Gallagher Warren Lenehan Hannah Gantly Ciaran Bolger Ailish Malone |
| author_facet | Caroline Treanor Conor Gallagher Warren Lenehan Hannah Gantly Ciaran Bolger Ailish Malone |
| author_sort | Caroline Treanor |
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| description | Introduction: People with Degenerative Cervical Myelopathy (DCM) often experience diagnostic delay. This could lead to poorer outcomes, including disability. Research question: Does the modified Japanese Orthopaedic Association scale (mJOA) have clinical utility as an early detection tool for possible DCM? Materials and methods: This is a prospective study of consecutive adult patients, referred to a National Neurosurgical Centre with a neck problem. Assessing clinicians undertook standard clinical examination and calculated the mJOA score. A consultant radiologist independently reported radiological findings, after which the assessing clinician determined the diagnosis. The sensitivity and specificity of mJOA for DCM at various cut-points was statistically analysed using Receiver Operating Characteristics (ROC) curves. Results: Of 201 patients (98 male, mean age 52.6 ± 13y) assessed over 13 months, 21 were diagnosed with DCM (prevalence 10.4%). Fifteen (71.4%) had a mJOA score classifying disease severity as mild, 4/21 (19%) had moderate disease and two (9.5%) had severe disease. A mJOA score ≤17 (cutpoint ≥1) showed sensitivity of 95% and specificity of 71% for the clinical diagnosis of DCM. mJOA score ≤16 (cutpoint ≥2) had sensitivity of 62% and specificity of 90%. The ROC area under the curve was 0.885 (95% confidence interval: 0.82 to 0.95). 87% of patients were correctly classified. Discussion and conclusion: mJOA score ≤16 is 90% specific for a subsequent diagnosis of DCM in people with neck problems and has potential to be used as an early detection tool. Further research is needed to replicate these findings and establish feasibility and acceptability in primary care. |
| format | Article |
| id | doaj-art-5f2ed5b8ed2348bdb54871b0ecf8ddf3 |
| institution | OA Journals |
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| language | English |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
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| series | Brain and Spine |
| spelling | doaj-art-5f2ed5b8ed2348bdb54871b0ecf8ddf32025-08-20T01:56:24ZengElsevierBrain and Spine2772-52942024-01-01410285310.1016/j.bas.2024.102853Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathyCaroline Treanor0Conor Gallagher1Warren Lenehan2Hannah Gantly3Ciaran Bolger4Ailish Malone5National Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland; School of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, IrelandNational Neurosurgical Centre, Beaumont Hospital, Dublin 9, IrelandNational Neurosurgical Centre, Beaumont Hospital, Dublin 9, IrelandSchool of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, IrelandNational Neurosurgical Centre, Beaumont Hospital, Dublin 9, Ireland; Department of Clinical Neuroscience, RCSI University of Medicine and Health Sciences, Dublin 2, IrelandSchool of Physiotherapy, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin 2, Ireland; Corresponding author.Introduction: People with Degenerative Cervical Myelopathy (DCM) often experience diagnostic delay. This could lead to poorer outcomes, including disability. Research question: Does the modified Japanese Orthopaedic Association scale (mJOA) have clinical utility as an early detection tool for possible DCM? Materials and methods: This is a prospective study of consecutive adult patients, referred to a National Neurosurgical Centre with a neck problem. Assessing clinicians undertook standard clinical examination and calculated the mJOA score. A consultant radiologist independently reported radiological findings, after which the assessing clinician determined the diagnosis. The sensitivity and specificity of mJOA for DCM at various cut-points was statistically analysed using Receiver Operating Characteristics (ROC) curves. Results: Of 201 patients (98 male, mean age 52.6 ± 13y) assessed over 13 months, 21 were diagnosed with DCM (prevalence 10.4%). Fifteen (71.4%) had a mJOA score classifying disease severity as mild, 4/21 (19%) had moderate disease and two (9.5%) had severe disease. A mJOA score ≤17 (cutpoint ≥1) showed sensitivity of 95% and specificity of 71% for the clinical diagnosis of DCM. mJOA score ≤16 (cutpoint ≥2) had sensitivity of 62% and specificity of 90%. The ROC area under the curve was 0.885 (95% confidence interval: 0.82 to 0.95). 87% of patients were correctly classified. Discussion and conclusion: mJOA score ≤16 is 90% specific for a subsequent diagnosis of DCM in people with neck problems and has potential to be used as an early detection tool. Further research is needed to replicate these findings and establish feasibility and acceptability in primary care.http://www.sciencedirect.com/science/article/pii/S2772529424001097Degenerative cervical myelopathyDiagnosisAssessment |
| spellingShingle | Caroline Treanor Conor Gallagher Warren Lenehan Hannah Gantly Ciaran Bolger Ailish Malone Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy Brain and Spine Degenerative cervical myelopathy Diagnosis Assessment |
| title | Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy |
| title_full | Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy |
| title_fullStr | Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy |
| title_full_unstemmed | Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy |
| title_short | Flipping the mJOA: Clinical utility of the modified Japanese Orthopaedic Association score as a tool for detecting degenerative cervical myelopathy |
| title_sort | flipping the mjoa clinical utility of the modified japanese orthopaedic association score as a tool for detecting degenerative cervical myelopathy |
| topic | Degenerative cervical myelopathy Diagnosis Assessment |
| url | http://www.sciencedirect.com/science/article/pii/S2772529424001097 |
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