The Nurick classification is a simple 0–5 clinical scale used mainly to grade the severity of cervical spondylotic myelopathy (CSM)—spinal cord dysfunction from cervical spine degeneration. It focuses on walking ability (gait), independence, and ability to work, with higher grades indicating worse neurologic disability.
Nurick grades
| Grade | Meaning |
| 0 | Nerve-root signs or symptoms only; no evidence of spinal cord involvement. |
| 1 | Signs of spinal cord disease, but no difficulty walking. |
| 2 | Slight gait difficulty, but the patient can still work full-time. |
| 3 | Gait difficulty prevents full-time work or all housework, but the patient can still walk without help. |
| 4 | Can walk only with another person’s assistance or a walking aid/frame. |
| 5 | Chair-bound (wheelchair-dependent) or bedridden. |
How it is used
- It gives clinicians a quick, standardized way to describe functional severity and track change before and after treatment, especially surgery.neurology+1
- A change of one Nurick grade is often treated as a clinically meaningful improvement or deterioration because the scale is ordinal.
- Lower grades (0–2) generally reflect better function; grades 4–5 indicate severe ambulatory disability and are associated with a more guarded prognosis, although decompressive surgery may still prevent progression.
Strengths and limitations
- Strengths: It is fast, easy to remember, and directly captures the most disabling feature of many myelopathy cases—impaired walking.
- Limitations: It does not separately measure hand function, sensation, pain, bladder/bowel symptoms, or overall quality of life. For a broader assessment, clinicians often use it alongside the modified Japanese Orthopaedic Association (mJOA) score, which includes upper-limb motor function, lower-limb motor function, sensation, and sphincter function.
Clinical example
A patient with neck/arm radiculopathy but a normal walk and no cord signs would be Nurick grade 0. If the same patient develops an unsteady gait but can continue working, they would be grade 2; if they need a walker to ambulate, they would be grade 4
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