The mJOA is clinician-administered, combining patient interview and direct observation of functional tasks. Consistent application is key for reliable results. This section outlines the general process and detailed scoring for the Benzel 18-point version.

1. Preparation & Setup:
   • Gather basic patient demographic and clinical information.
   • Have the mJOA scoring sheet and instructions readily available.
   • Ensure a suitable environment for observation if needed.
2. Domain-by-Domain Assessment & Scoring: Systematically evaluate and score each of the four functional domains:
   • I. Upper Extremity Motor Function (Max Score: 5)

     Assesses hand dexterity and ability to perform common ADLs.

     • 5 points: No dysfunction.
     • 4 points: Able to button shirt with slight difficulty.
     • 3 points: Able to button shirt with great difficulty.
     • 2 points: Inability to button shirt but able to eat with a spoon.
     • 1 point: Inability to eat with a spoon but able to move hands.
     • 0 points: Inability to move hands.
   • II. Lower Extremity Motor Function (Max Score: 7)

     Evaluates walking capability, balance, need for walking aids, and ability to navigate stairs.

     • 7 points: No dysfunction.
     • 6 points: Mild disturbance of gait; able to walk unaided with smooth reciprocation; >30% of time spent on one leg during single stance phase is possible.
     • 5 points: Moderate to marked disturbance of gait but able to walk unaided; >30% of time spent on one leg during single stance phase is not possible.
     • 4 points: Able to walk up and/or down stairs with handrail.
     • 3 points: Able to walk on flat floor with walking aid (cane or walker).
     • 2 points: Able to move legs but unable to walk.
     • 1 point: Sensory preservation without ability to move legs.
     • 0 points: Complete loss of motor and sensory function.
   • III. Upper Extremity Sensory Function (Max Score: 3)

     Inquires about the presence and severity of sensory deficits (numbness, tingling, pain) in the hands.

     • 3 points: No sensory loss.
     • 2 points: Mild sensory loss.
     • 1 point: Severe sensory loss or pain.
     • 0 points: Complete loss of hand sensation.
   • IV. Sphincter (Bladder) Function (Max Score: 3)

     Assesses degree of difficulty with micturition and urinary continence.

     • 3 points: Normal micturition.
     • 2 points: Mild to moderate difficulty with micturition.
     • 1 point: Marked difficulty with micturition.
     • 0 points: Inability to urinate voluntarily.
3. Assign Scores: For each item within the domains, select and record the score that best reflects the patient's current functional level according to the specific criteria for that item.
4. Calculate Total Score: Sum the scores from all four domains to obtain the total mJOA score. The maximum possible score is 18.
5. Classify Severity: Use the total mJOA score to classify the severity of myelopathy: Mild (15-17), Moderate (12-14), or Severe (0-11).

Best Practices for Administration:

• Employ consistent questioning techniques for all patients.
• Provide clear and simple instructions to the patient.
• Maintain objective observation standards when assessing functional tasks.
• Formal training in mJOA administration is highly recommended to enhance inter-rater reliability and ensure accurate scoring.