Spine scales

Compiled by:
G Narenthiran

| Frankel Classification | Nurick classification | Ranawat Classification | JOA scale | Chiles et al's modified JOA scale | Benzel et al's modified JOA scale | ASIA score | McCormick classification |

Acute spinal cord injury - Frankel Classification grading system

Grade A Complete neurological injury - no motor or sensory function clinically detected below the level of the injury.
Grade B Preserved sensation only - no motor function clinically detected below the level of the injury; sensory function remains below the level of the injurybut may include only partial function (sacral sparing qualifies as preserved sensation).
Grade C Preserved motor non-functional - some motor function observed below the level of the injury, but is of no practical use to the patient.
Grade D Preserved motor function - useful motor function below the level of the injury; patient can move lower limbs and walk with or without aid, but does not have a normal gait or strength in all motor groups.
Grade E Normal motor - no clinically detected abnormality in motor or sensory function with normal sphincter function; abnormal reflexes and subjective sensory abnormalities may be present.


Nurick's classification system for myelopathy on the basis of gait abnormalities

Grade Root signs Cord involvement Gait Employment
0 Yes No Normal Possible
I Yes Yes Normal Possible
II Yes Yes Mild abnormality Possible
III Yes Yes Severe abnormality Impossible
IV Yes Yes Only with assistance Impossible

Nurick S. The pathogenesis of spinal cord disorder associated with cervical spondylosis. Brain 1972; 95: 87-100


Ranawat Classification of Neurologic Deficit

Class I Pain, no neurologic deficit
Class II Subjective weakness, hyperreflexia, dyssthesias
Class III Objective weakness, long tract signs
Class IIIA Class III, ambulatory
Class IIIB Class III, nonambulatory

Ranawat CS, O'Leary P, Pellicci P, et al. Cervical fusion in rheumatoid arthritis. J Bone Joint Surg Am 1979; 61: 1003-1010



The Japanese Orthopaedic Association scale: An objective assessment scale quantitating the severity of the spondylotic myelopathy based on four categories:


Chiles et al's modified version of the Japanese Orthopaedic Association Scale:



Benzel et. al.'s modified Japanese Orthopaedic Association Scale

American Spinal Injury Association score:


cCormick functional classification of intramedullary spinal cord tumours (simplified)

Grade Desciption
I Neurologically normal, mild focal deficits, normal gait
II Sensorimotor deficits affecting function, severe pain, gait difficulties, can still walk
III Moderate neurological deficit, reques cane for ambulation, +/- arms affected, +/- imdependent
IV As above + arms affected, usually not independent

Ref.: George Samandouras. The Neurosurgeon's Handbook. Oxford, 2010. p862