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Cervical Spondylosis N003

Document
Last amended 
19 September 2017
Current RMA Instruments:
Reasonable Hypothesis SOP
66 of 2014
Balance of Probabilities SOP 67 of 2014
Changes from previous Instruments

SOP Bulletin 176

ICD Coding
  • ICD-9-CM Codes: 721.0,721.1,722.4
  • ICD-10-AM code M47.01, M47.02, M47.03, M47.11, M47.12, M47.13, M47.21, M47.22, M47.23, M47.81, M47.82, M47.83, M47.91, M47.92, M47.93 or M50.3
Brief description

Cervical spondylosis is a degenerative disease affecting the joints of the cervical spine, i.e. the intervertebral discs and the facet joints (zygapophyseal joints).  The cervical spine includes all cervical vertebra from C1 to C7 as well as the cervico-thoracic junction (C7/T1).

Confirming the diagnosis

To confirm the diagnosis there needs to be both:

  • evidence of clinical symptoms and signs (pain, stiffness, nerve involvement) at the affected level/s;

AND

  • Imaging (X-ray, CT, MRI) evidence of degenerative changes, particularly disc degeneration and osteophyte (bony spur) formation.

Either symptoms/signs alone or radiological evidence alone is insufficient for diagnosis, both components must be present.

The relevant medical specialist is an orthopaedic surgeon, rheumatologist or neurologist.

Additional diagnoses covered by this SOP
  • Osteoarthritis of the cervical spine.
  • Degenerative disc disease of the cervical spine.
  • Facet joint osteoarthritis of the cervical spine.
Conditions which may be covered by this SOP
  • Cervical disc prolapse or herniation – An isolated cervical disc prolapse is covered by the intervertebral disc prolapse SOP. However, if the cervical disc prolapse occurs in the presence of pre-existing cervical spondylosis, it is likely that the new cervical disc prolapse, is an integral manifestation of the cervical spondylosis rather than a separate disease.
  • Cervical spinal stenosis – The stenosis may be a separate additional pathology or may be an integral manifestation of the cervical spondylosis rather than a separate disease. Separate cervical spinal stenosis may be due to congenital/developmental anomaly; disc prolapse; other space occupying lesions such as neoplasia.
  • Cervical spine spondylolisthesis - If degenerative (that is, not due to spondylolysis (pars defects).
Conditions excluded from this SOP
  • Ankylosing spondylitis*
  • Diffuse Idiopathic Skeletal Hyperostosis (DISH)#
  • Facet joint dysfunction
  • Isolated bulging of a disc – A disc bulge without any other concomitant signs of disc pathology such as disc desiccation, annular tears, endplate changes, osteophytes, is likely to be a physiological change, and hence not currently a disease or injury.
  • Musculoligamentous strain or sprain of the cervical spine*
  • Rheumatoid arthritis*

* another SOP applies  - the SOP has the same name unless otherwise specified

# non-SOP condition

Clinical onset

Once the diagnosis has been confirmed (including by having imaging evidence of degeneration), it may be possible to back-date clinical onset based on the relevant associated symptoms, particularly pain.  The nature and pattern of the symptoms (location/ level, temporal connection, persistence etc.) needs to be consistent with a degenerative origin.  Clinical onset may be pointed to by symptoms that commenced (and then persisted) from days up to a few months before confirmation of diagnosis.  However, neck pain is a non-specific symptom, with other possible causes.  Time of clinical onset should generally not be based on earlier symptom episodes, particularly if intermittent.  The clinical onset will not be at the time of an initiating trauma/injury.  The degeneration takes time to develop following a trauma.

Clinical worsening

The natural history of cervical spondylosis is for the degenerative changes to slowly progress and worsen.  The symptoms may fluctuate over time and may improve in some cases.  Conventional medical therapy and operative treatment may alleviate symptoms but will not slow or reverse the condition.

Further comments on diagnosis

If degenerative changes in the cervical spine are confined to one level then the level should be included in the diagnostic label, e.g. “cervical spondylosis C4/5”.  If multiple levels are involved then specifying the levels is not necessary.