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Lumbar Spondylosis N004

Document
Last amended 
19 September 2017
Current RMA Instruments
Reasonable Hypothesis SOP 62 of 2014
Balance of Probabilities SOP
63 of 2014
Change to previous Instruments

SOP Bulletin 176

ICD Coding
  • ICD-9-CM Code: 721.3,721.42,722.52
  • ICD-10-AM Codes: M47.16, M47.17, M47.26, M47.27, M47.86, M47.87, M47.96, M47.97, M51.3
Brief description

Lumbar spondylosis is a degenerative disease affecting the joints in the lumbar spine, i.e. the intervertebral discs and the facet joints (zygapophyseal joints).   It results from mechanical joint stress.  It results in low back pain and stiffness and may be associated with sciatica (pain, numbness or weakness down into the leg due to nerve compression).  The lumbar spine includes all lumbar vertebrae from L1 to L5 as well as the Lumbosacral junction (L5/S1).

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 these SOPs
  • Degenerative disc disease of the lumbar spine.
  • Disc desiccation of the lumbar spine.
  • Facet joint osteoarthritis of the lumbar spine.
  • Osteoarthritis of the lumbar spine.
Conditions which may be covered by these SOPs
  • Lumbar disc prolapse or herniation – An isolated lumbar disc prolapse is covered by the intervertebral disc prolapse SOP. However, if the lumbar disc prolapse occurs in the presence of pre-existing lumbar spondylosis, it is likely that the new lumbar disc prolapse is an integral manifestation of the lumbar spondylosis rather than a separate disease.
  • Lumbar spinal stenosis – The stenosis may be a separate additional pathology or may be an integral manifestation of the lumbar spondylosis rather than a separate disease. Separate lumbar spinal stenosis may be due to congenital/developmental anomaly, disc prolapse, or other space occupying lesions such as neoplasia.
  • Lumbar spine spondylolisthesis - If degenerative (that is not due to spondylolysis, i.e. pars defects).
Conditions not covered by these SOPs 
  • Ankylosing spondylitis*
  • Congenital transitional lumbosacral vertebrae#                                       
  • Diffuse Idiopathic Skeletal Hyperostosis (DISH) #
  • 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 a disease or injury.
  • Musculoligamentous strain or sprain of the lumbar spine*   Sprain and strain SOP   

* 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, back 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 lumbar 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 lumbar spine are confined to one level then the level should be included in the diagnostic label, e.g. “lumbar spondylosis L4/5”.  If multiple levels are involved then specifying the levels is not necessary.