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Other surgeons prefer to do an open procedure

JOA improvement rate = [(JOA score after treatment JOA score before treatment)/(29 JOA score before treatment)] 100%

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Supplementation strategies vary depending on the underlying cause of deficiency or risk factors: Oral supplements (typically 25-2000 micrograms daily) are suitable for individuals with adequate intrinsic factor production but insufficient dietary intake Sublingual or buccal preparations have no proven superiority over standard oral tablets at equivalent doses Intramuscular injections (usually 1000 micrograms of hydroxocobalamin) are the preferred treatment for pernicious anaemia and severe malabsorption