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Lumbar Spondylosis N004
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Current RMA Instruments
|Reasonable Hypothesis SOP||62 of 2014|
|Balance of Probabilities SOP||63 of 2014|
Change to previous Instruments
- 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
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
The diagnosis requires both clinical manifestations (symptoms and signs) and evidence of relevant bone/joint pathology (osteophytes, disc space narrowing, facet joint degeneration). Imaging (X-ray, CT, MRI) evidence is required by the SOP definition and should be used to confirm the pathological changes, unless it can't be obtained (see comments below).
The relevant medical specialist is an orthopaedic surgeon, rheumatologist or neuro/spinal surgeon.
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
Once the diagnosis has been confirmed it may be possible to back-date clinical onset based on the relevant associated symptoms. Back pain is a non-specific symptom, with other possible causes. The nature and pattern of the symptoms (location, temporal connection, persistence etc.) needs to be consistent with a degenerative origin. Difficulties in assessing onset may arise where a prior acute back injury, or surgery (e.g. for a disc prolapse) has occurred and symptoms have persisted subsequently. The time to develop clinically apparent spondylosis post injury is variable and dependent on factors such as the nature and extent of the injury and age. Most commonly, spondylosis onset following a joint injury occurs between ages 40 and 50. Onset may be as soon as 5 years post injury, particularly if of older age at the time of injury, but is more likely to be 10 years or more (and up to several decades later), particularly if the injury occurred at a young age (<25). The clinical onset will not be at the time of an initiating trauma/injury. The degeneration takes time to develop following a trauma.
Imaging evidence of joint degeneration does not establish a clinical onset, as clinical manifestations from the degeneration are required. However, in the case of a prior injury or joint disorder, in the absence of a change in symptoms, and where a diagnosis of spondylosis has been made, date of first imaging showing degeneration may provide the only available marker for the time of clinical onset.
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
In exceptional circumstances the diagnosis may be confirmed without imaging, in a person > 50 years, with typical clinical manifestations, and in whom imaging cannot reasonably be undertaken or obtained.