Nurick Classification

Original Editor - Momina Khalid Top Contributors - Momina Khalid and Kim Jackson

Purpose[edit | edit source]

The Nurick classification is a widely used scale used to assess functional disability in patients with cervical spondylotic myelopathy (CSM).

Signs and Symptoms[edit | edit source]

Clinical signs and symptoms observed in cervical myelopathy patients include [1]

  • Weakness
  • Impaired gait
  • Hands numbness
  • Neck pain
  • Arm pain

Nurick Classification[edit | edit source]

The Nurick classification is the oldest classification, proposed in 1972. This is widely used to grade the degree of ambulatory status. Therefore, walking disturbances can be classified based on the Nurick classification. This scale relates lower-limb mobility to employability. Nurick classifies myelopathy symptoms on a 6-grade scale. The categories range from a grade of zero to five, where zero means that the patient only has root symptoms and grade five implies that the patient is either wheelchair-bound or bedridden.[2]

Grade Classification[edit | edit source]

Nurick Grade For Myelopathy [3]
Grade Signs and Symptoms
0 Root symptoms only or normal
1 Signs of cord compression; normal gait
2 Gait difficulties but fully employed
3 Gait difficulties prevent employment; walks unassisted
4 Unable to walk without assistance
5 Wheelchair or bed-bound

Modified Japanese Orthopedic Association Scoring system[edit | edit source]

Hukuda introduced the Japanese Orthopedic Association (JOA) Scale for CSM in 1985. It consists of 17 points in total. In 1991, Benzel,et al. modified this scale to a 20-point scale. This scoring system is widely used and is called the Modified Japanese Orthopedic Association Scale (mJOA).[4]

Grade Classification[edit | edit source]

Modified Japanese Orthopedic Association (mJOA) grading system
Criteria Content Point
Upper Extremity
Motor Unable to move hands 0
Unable to eat with a spoon but able to move hands 1
Unable to button shirt but able to eat with a spoon 2
Able to button shirt with great difficulty 3
Able to button shirt with slight difficulty 4
No dysfunction 5
Lower Extremity Complete loss of motor & sensory function 0
Sensory preservation without ability to move legs 1
Able to move legs but unable to walk 2
Able to walk on flat floor with a walking aid (cane or crutch) 3
Able to walk up- &/or downstairs w/aid of a handrail 4
Moderate-to-significant lack of stability but able to walk up- &/or downstairs without handrail 5
Mild lack of stability but able to walk unaided with smooth reciprocation 6
No dysfunction 7
Sensory Upper Extremities Complete loss of hand sensation 0
Severe sensory loss or pain 1
Mild sensory loss 2
No sensory loss 3
Sphincter Dysfunction Unable to micturate voluntarily 0
Marked difficulty in micturition 1
Mild-to-moderate difficulty in micturition 2
Normal micturition 3
Total 18

Correlation between the Nurick and Modified Japanese Orthopedic Association[edit | edit source]

The Nurick grade was developed to establish the correlation between the degree of cord compression and the severity of symptoms in cervical spondylotic myelopathy (CSM). The correlation between Nurick grade and modified japanese mJOA score was stronger in patients with moderate myelopathy than in those with mild and severe ones. In conclusion, both Nurick scale and mJOA score were used in evaluation of patients with cervical spondylotic myelopathy, that addresses all aspects of function.[2]

References[edit | edit source]

  1. Mehmet Zileli, Sachin Borkar, Sinha S, Jutty K B C Parthiban. Cervical Spondylotic Myelopathy: Natural Course and the Value of Diagnostic Techniques –WFNS Spine... [Internet]. ResearchGate. The Korean Spinal Neurosurgery Society (KAMJE); 2019 [cited 2023 Nov 26]. Available from:‌
  2. 2.0 2.1 Muhamad F, Baha A, Haynes G, Zachary Adam Smith. Isolating Neurologic Deficits in Cervical Spondylotic Myelopathy: A Case-Controlled Study, Using the NIH... [Internet]. ResearchGate. American Academy of Orthopaedic Surgeons; 2023 [cited 2023 Nov 26]. Available from:‌
  3. Wilson JR, Barry SP, Fischer DJ, Skelly AC, Arnold PM, K. Daniel Riew, et al. Frequency, Timing, and Predictors of Neurological Dysfunction in the Nonmyelopathic Patient With Cervical Spinal Cord Compression, Canal Stenosis, and/or Ossification of the Posterior Longitudinal Ligament. Spine [Internet]. 2013 Oct 1 [cited 2023 Nov 27];38:S37–54. Available from:,_Timing,_and_Predictors_of_Neurological.5.aspx?casa_token=KJPQTZKDuOIAAAAA:BMQO-0m7HF3GerwDUFpNjJh9Mzjf_0KNWiKVBSGtyjvnWWyWcwYghgSQnZxtfrAUMytn2ZehvVQ6l3IFWMGuiJB1Mx0
  4. 1. Benzel EC, Lancon J, Kesterson L, Hadden TA. Cervical Laminectomy and Dentate Ligament Section for Cervical Spondylotic Myelopathy. Journal of Spinal Disorders [Internet]. 1991 Sep 1 [cited 2023 Nov 27];4(3):286–95. Available from: