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Thoracic Spondylosis N030
In this section
Current RMA Instruments
|Reasonable Hypothesis SOP||64 of 2014|
|Balance of Probabilities SOP||65 of 2014|
Changes from previous Instruments
- ICD-9-CM Codes: 721.2,721.41,722.51,721.4,722.5,722.6
- ICD-10-AM Codes: M47.14, M47.15, M47.24, M47.25, M47.84, M47.85, M47.94, M47.95, M51.3
Thoracic spondylosis is a degenerative disease affecting the joints in the thoracic spine, i.e. the intervertebral discs and the facet joints (zygapophyseal joints). It results from mechanical joint stress. It results in upper to mid back pain and stiffness. The thoracic spine includes all thoracic vertebra from T1 to T12 as well as the thoraco-lumbar junction (T12/L1).
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;
- 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 or rheumatologist.
Additional diagnoses covered by these SOPs
- Degenerative disc disease of the thoracic spine.
- Disc desiccation of the thoracic spine.
- Facet joint osteoarthritis of the thoracic spine.
- Osteoarthritis of the throacic spine.
Conditions which may be covered by these SOPs
- Thoracic disc prolapse or herniation – An isolated thoracic disc prolapse is covered by the intervertebral disc prolapse SOP. However, if the thoracic disc prolapse occurs in the presence of pre-existing thoracic spondylosis, it is likely that the new thoracic disc prolapse is an integral manifestation of the thoracic spondylosis rather than a separate disease.
- Thoracic spinal stenosis – The stenosis may be a separate additional pathology or may be an integral manifestation of the thoracic spondylosis rather than a separate disease. Separate thoracic spinal stenosis may be due to congenital/developmental anomaly, disc prolapse, or other space occupying lesions such as neoplasia.
Conditions not covered by these SOPs
- Ankylosing spondylitis*
- 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 thoracic spine* - Sprain and strain SOP
- Scheuermann’s disease#
* another SOP applies - the SOP has the same name unless otherwise specified
# non-SOP condition
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.
The natural history of thoracic 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 thoracic spine are confined to one level then the level should be included in the diagnostic label, e.g. “thoracic spondylosis T11/12”. If multiple levels are involved then specifying the levels is not necessary.