Treatment of Moderate Degenerative Cervical Myelopathy with MRI-Confirmed Spinal Cord Compression (mJOA Score 12–14)

Clinical Scenario

This protocol addresses patients with degenerative cervical myelopathy (DCM) who present with signs and symptoms of cervical myelopathy together with imaging evidence — typically cervical MRI — confirming spinal cord compression, and whose neurological function is classified as moderate based on the modified Japanese Orthopedic Association (mJOA) scale.

Severity Classification (mJOA)

Category	mJOA Score
Mild	15
Moderate (this protocol)	12 – 14
Severe	11 or below

Diagnostic Requirements

Diagnosis requires both clinical signs and symptoms consistent with myelopathy and imaging evidence of cervical spinal cord compression. MRI is the primary modality used to confirm the presence and extent of compression.

Treatment Direction

For patients with moderate DCM, the recommended approach involves a surgical intervention directed at the cervical spinal cord. The specific technique, operative planning, and perioperative considerations are detailed in the complete protocol.

Treatment Goal

A successful outcome is defined as achieving a final postoperative mJOA score of 16 or higher — reflecting meaningful neurological recovery.

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References

DOI: 10.1177/2192568217703088

Based on the mJOA score, mild myelopathy is defined as 15, moderate as 12 to 14, and severe as 11.

DCM is diagnosed when a patient presents with signs and symptoms consistent with myelopathy and image (usually magnetic resonance imaging [MRI]) evidence of spinal cord compression.

We recommend surgical intervention for patients with moderate DCM.

Success has been defined based on final postoperative score (eg, mJOA 16), recovery rate or achieving a MCID.

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