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Research ArticleCervical Spine

Development and Validation of the 17-Point Brazilian Portuguese Translated Version of the Modified Japanese Orthopedic Association Score (mJOA-BR17)

Pedro Pohl, Helena Bruna Bettoni Volpato, Lucas Seabra Fernandes, Marcel Lobato Sauma, Takashi Yurube, Gilbert Bang, Rodrigo Góes Medéa de Mendonça, Luciano Miller Reis Rodrigues and Mario Lenza
International Journal of Spine Surgery December 2023, 17 (6) 875-881; DOI: https://doi.org/10.14444/8554
Pedro Pohl
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
MD, PhD
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  • For correspondence: pedro.pohl@einstein.br
Helena Bruna Bettoni Volpato
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
PT
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Lucas Seabra Fernandes
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
MD
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Marcel Lobato Sauma
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
MD
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Takashi Yurube
2 Department of Orthopedic Surgery, Kobe University Graduate School of Medicine, Hyogo, Japan
MD, PhD
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Gilbert Bang
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
MD, MSc
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Rodrigo Góes Medéa de Mendonça
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
MD, PhD
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Luciano Miller Reis Rodrigues
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
MD, PhD
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Mario Lenza
1 Department of Orthopedic Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
MD, PhD
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    Figure

    Receiver operating characteristic curve 17-point Brazilian Portuguese translated version of the modified Japanese Orthopedic Association score. Area under the curve is 0.81.

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    Table 1

    mJOA and final mJOA-BR17.

    mJOA9 Final mJOA-BR17Points
    PortugueseEnglish Translation
    I. Motor dysfunction of the upper extremity Função motora dos Membros Superiores Motor function of upper limbs
    Unable to feed oneselfIncapaz de se alimentarUnable to feed oneself0
    Unable to use knife and fork; able to eat with spoonIncapaz de usar garfo e faca, mas consegue comer com uma colherUnable to use fork and knife; able to eat with a spoon1
    Able to use knife and fork with much difficultyCapaz de usar garfo e faca com muita dificuldadeAble to use fork and knife with much difficulty2
    Able to use knife and fork with slight difficultyCapaz de usar garfo e faca com alguma dificuldadeAble to use fork and knife with some difficulty3
    NoneNormalNormal4
    II. Motor dysfunction of the lower extremity Função motora dos Membros Inferiores Motor function of lower limbs
    Unable to walkIncapaz de andarUnable to walk0
    Can walk on flat floor with walking aidCapaz de andar em piso plano com auxílio (bengalas, muletas ou andador)Capable to walk on flat floor with aid (walking sticks, crutches, or walking devices)1
    Can walk up and/or down stairs with handrailCapaz de subir ou descer escadas com auxílio do corrimãoCapable to walk up or downstairs with handrail aid2
    Lack of stability and smooth gaitCapaz de andar, subir e/ou descer escadas sem corrimão porém com alguma instabilidadeCapable of walking, walk up and/or downstairs without handrail aid, with some instability3
    NoneMarcha normalNormal gait4
    III. Sensory deficit Déficit sensitivo Sensory deficit
    Upper extremityMembros superioresUpper limbs
     Upper extremity, severe sensory loss, or pain Membros superiores, perda sensitiva severa ou dor Upper limbs, severe sensory loss, or pain0
     Upper extremity and mild sensory loss Membros superiores, perda sensitive leve Upper limbs and mild sensory loss1
     Upper extremity and none Membros superiores, sem perda sensitiva Upper limbs and no sensory loss2
    Lower extremityMembros inferioresLower Limbs
     Lower extremity, severe sensory loss, or pain Membros inferiores, perda sensitiva severa ou dor Lower limbs, severe sensory loss, or pain0
     Lower extremity and mild sensory loss Membros inferiores, perda sensitive leve Lower limbs and mild sensory loss1
     Lower extremity and none Membros inferiores, sem perda sensitiva Lower limbs and no sensory loss2
    TrunkTroncoTrunk
     Trunk, severe sensory loss, or pain Tronco, perda sensitiva severa ou dor Trunk, severe sensory loss, or pain0
     Trunk and mild sensory loss Tronco, perda sensitive leve Trunk and mild sensory loss1
     Trunk and none Tronco, sem perda sensitiva Trunk and no sensory loss2
    IV. Sphincter dysfunction Disfunção esfincteriana Sphincter dysfunction
    Unable to voidIncapaz de urinar espontaneamenteUnable to urinate spontaneously0
    Marked difficulty in micturition (retention)Capaz de urinar, porém apresenta retençãoCapable to urinate, but with retention1
    Difficulty in micturition (frequency and hesitation)Dificuldade na micção (aumento de frequência e/ou hesitação)Difficulty in micturition (increase in frequency and/or hesitation)2
    NoneAusenteAbsent3
    • Abbreviations: mJOA, modified Japanese Orthopedic Association; mJOA-BR17, 17-point Brazilian Portuguese modified Japanese Orthopedic Association.

    • Note: The mJOA and mJOA-BR17 result in a total score ranging from 0 to 17. A normal score is 17 points.

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    Table 2

    Summary of age, mJOA-BR17 total score, and VAS.

    VariablesTotalControl GroupCSM Group P Value
    Age, y   0.120
     Mean (SD)59.74 (11.62)62.45 (11.42)56.90 (11.41) 
     Median (IIQ)61.00 (52.00; 68.00)62.00 (56.50; 69.25)57.00 (48.00; 62.00) 
     Minimum–maximum (n)35.00–86.00 (43)36.00–86.00 (22)35.00–79.00 (21) 
    VAS   <0.001
     Mean (SD)1.82 (2.91)0.00 (0.00)4.73 (2.87) 
     Median (IIQ)0.00 (0.00; 4.50)0.00 (0.00; 0.00)5.00 (3.00; 6.50) 
     Minimum–maximum (n)0.00–9.00 (39)0.00–0.00 (24)0.00–9.00 (15) 
    mJOA-BR17 total score   <0.001
     Mean (SD)15.37 (2.47)16.68 (0.59)14.14 (2.92) 
     Median (IIQ)16.00 (15.00; 17.00)17.00 (16.25; 17.00)15.00 (13.00; 16.25) 
     Minimum–maximum (n) 7.00–17.00 (70)15.00–17.00 (34) 7.00–17.00 (36) 
    mJOA-BR17 – motor dysfunction upper extremity   0.007
     Mean (SD)3.71 (0.68)3.94 (0.24)3.50 (0.88) 
     Median (IIQ)4.00 (4.00; 4.00)4.00 (4.00; 4.00)4.00 (3.00; 4.00) 
     Minimum–maximum (n)1.00–4.00 (70)3.00–4.00 (34)1.00–4.00 (36) 
    mJOA-BR17 – motor dysfunction lower extremity   <0.001
     Mean (SD)3.57 (0.83)3.91 (0.29)3.25 (1.02) 
     Median (IIQ)4.00 (3.25; 4.00)4.00 (4.00; 4.00)4.00 (2.00; 4.00) 
     Minimum–maximum (n)0.00–4.00 (70)3.00–4.00 (34)0.00–4.00 (36) 
    mJOA-BR17 – sensory deficit upper extremity   <0.001
     Mean (SD)1.50 (0.72)1.85 (0.36)1.17 (0.81) 
     Median (IIQ)2.00 (1.00; 2.00)2.00 (2.00; 2.00)1.00 (0.75; 2.00) 
     Minimum–maximum (n)0.00–2.00 (70)1.00–2.00 (34)0.00–2.00 (36) 
    mJOA-BR17 – sensory deficit lower extremity   <0.001
     Mean (SD)1.80 (0.50)2.00 (0.00)1.61 (0.64) 
     Median (IIQ)2.00 (2.00; 2.00)2.00 (2.00; 2.00)2.00 (1.00; 2.00) 
     Minimum–maximum (n)0.00–2.00 (70)2.00–2.00 (34)0.00–2.00 (36) 
    mJOA-BR17 – sensory deficit trunk   0.173
     Mean (SD)1.96 (0.27)2.00 (0.00)1.92 (0.37) 
     Median (IIQ)2.00 (2.00; 2.00)2.00 (2.00; 2.00)2.00 (2.00; 2.00) 
     Minimum–maximum (n)0.00–2.00 (70)2.00–2.00 (34)0.00–2.00 (36) 
    mJOA-BR17 – sphincter dysfunction   0.005
     Mean (SD)2.83 (0.42)2.97 (0.17)2.69 (0.52) 
     Median (IIQ)3.00 (3.00; 3.00)3.00 (3.00; 3.00)3.00 (2.00; 3.00) 
     Minimum–maximum (n)1.00–3.00 (70)2.00–3.00 (34)1.00–3.00 (36) 
    • Abbreviations: CSM, cervical spondylotic myelopathy; IIQ, interquantile range; mJOA-BR17, 17-point Brazilian Portuguese translated version of the modified Japanese Orthopedic Association score; VAS, visual analog scale.

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    Table 3

    Results of the mJOA-BR17 domains.

    VariablesTotalControl GroupCSM Group
    Motor dysfunction upper extremity   
     12 (2.9)0 (0.0)2 (5.6)
     23 (4.3)0 (0.0)3 (8.3)
     38 (11.4)2 (5.9)6 (16.7)
     457 (81.4)32 (94.1)25 (69.4)
    Motor dysfunction lower extremity   
     01 (1.4)0 (0.0)1 (2.8)
     29 (12.9)0 (0.0)9 (25.0)
     38 (11.4)3 (8.8)5 (13.9)
     452 (74.3)31 (91.2)21 (58.3)
    Sensory deficit upper extremity   
     09 (12.9)0 (0.0)9 (25.0)
     117 (24.3)5 (14.7)12 (33.3)
     244 (62.9)29 (85.3)15 (41.7)
    Sensory deficit lower extremity   
     03 (4.3)0 (0.0)3 (8.3)
     18 (11.4)0 (0.0)8 (22.2)
     259 (84.3)34 (100.0)25 (69.4)
    Sensory deficit trunk   
     01 (1.4)0 (0.0)1 (2.8)
     11 (1.4)0 (0.0)1 (2.8)
     268 (97.1)34 (100.0)34 (94.4)
    Sphincter dysfunction   
     11 (1.4)0 (0.0)1 (2.8)
     210 (14.3)1 (2.9)9 (25.0)
     359 (84.3)33 (97.1)26 (72.2)
    • Abbreviation: CSM, cervical spondylotic myelopathy.

    • Note: Data presented as n (%).

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Development and Validation of the 17-Point Brazilian Portuguese Translated Version of the Modified Japanese Orthopedic Association Score (mJOA-BR17)
Pedro Pohl, Helena Bruna Bettoni Volpato, Lucas Seabra Fernandes, Marcel Lobato Sauma, Takashi Yurube, Gilbert Bang, Rodrigo Góes Medéa de Mendonça, Luciano Miller Reis Rodrigues, Mario Lenza
International Journal of Spine Surgery Dec 2023, 17 (6) 875-881; DOI: 10.14444/8554

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Development and Validation of the 17-Point Brazilian Portuguese Translated Version of the Modified Japanese Orthopedic Association Score (mJOA-BR17)
Pedro Pohl, Helena Bruna Bettoni Volpato, Lucas Seabra Fernandes, Marcel Lobato Sauma, Takashi Yurube, Gilbert Bang, Rodrigo Góes Medéa de Mendonça, Luciano Miller Reis Rodrigues, Mario Lenza
International Journal of Spine Surgery Dec 2023, 17 (6) 875-881; DOI: 10.14444/8554
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