Spondylolisthesis and Spondylolysis N039
Current RMA Instruments
| Reasonable Hypothesis SOP [1] | 24 of 2017 |
| Balance of Probabilities SOP [2] | 25 of 2017 |
Changes from previous Instruments
Bulletin 195.pdf [3]
ICD Coding:
- ICD-9-CM: 738.4, 756.11, 756.12
- ICD-10-AM: M43.0, M43.1, Q76.21, Q76.22
Brief description:
The SOP covers:
- Spondylolysis, which is a fracture or defect of a specific part of a vertebra (the pars interarticularis).
- Spondylolisthesis, which is displacement of one vertebra relative to the one below. Spondylolisthesis is most commonly a forward displacement of a vertebra relative to the one below (anterolisthesis), but uncommonly, there may be backward displacement of a vertebra relative to the one below (retrolisthesis).
Spondylolisthesis is mostly secondary to spondylolysis, but can also be due to spondylosis and some other causes.
Spondylolysis occurs at the L5 level of the lumbar spine in around 90% of cases, with the remainder almost all at L4.
Confirming the diagnosis
Diagnosis requires X-ray, CT scan or MRI scan showing a pars interarticularis fracture or displacement of one vetebra relative to the one below.
The specific type of the condition (see further comments below) needs to be known to apply some of the SOPs factors. This will be evident from the imaging.
The relevant specialist is an orthopaedic surgeon.
Additional diagnoses covered by SOP
- Anterolisthesis
- Retrolisthesis
- Degenerative spondylolisthesis
Conditions not covered by these SOPs
- Spondylosis*
* another SOP applies
Further comments on diagnosis
Types:
- Spondylolysis - pars interarticularis fracture (usually bilateral), without vertebral displacement. The pars interarticularis is a segment of bone on the vertebral arch at the back of the vertebra which connects the superior articular facet to the inferior articular facet. It is best seen on oblique X-ray views as the collar on the ‘scottie dog’ image. This condition is either developmental – normally occurring in childhood at around 8 yrs of age, or a stress (overuse) fracture in child and adolescent athletes.
- Spondylolytic spondylolisthesis - forward displacement of vertebra + bilateral pars interarticularis fracture.
- Degenerative spondylolisthesis - displacement of vertebra associated with degeneration of facet joints and the absence of pars interarticularis fracture/s. This occurs later in life and typically where there is advanced degenerative disease of the facet joints.
- Spondylolisthesis may also rarely arise due to congenital dysplasia of the vertebrae, following severe, high impact trauma, or from bone pathology such as from osteomyelitis or an invasive neoplasm.
- Retrolisthesis usually affects the cervical spine or the lumbar spine, most commonly in the setting of degenerative changes (spondylosis).
Clinical onset
The condition may be asymptomatic and found incidentally on X-ray. This is particularly the case when it develops in early life. In adolescent athletes onset is usually gradual, in the form of low back pain with activity. It is not usually associated with an acute event. Spondylolysis or spondylolytic spondylolisthesis is unlikely to be the cause of new onset back pain in an adult (especially if ≥ 25 yrs). Degenerative spondylolisthesis and retrolisthesis usually manifest later in life in the setting of advanced degenerative disease.
Clinical worsening
Documented progression from spondylolysis to spondylolisthesis or an increase in the degree of slipping would represent a clinical worsening.
Factors in CCPS as at 16 September 2011 (N039)
- Log in [4] to post comments
Important Information
- The investigation questions displayed here are based on factors that were current at the time that they were incorporated into the CCPS application.
- There may have been new instruments for this SOP condition issued after they were added to the CCPS application.
- Please ensure that you refer to and use the latest instruments for this SOP condition (spondylolisthesis and spondylolysis).
Current Statements of Principles
- Please refer to the Repatriation Medical Authority (RMA) Website to confirm the most recent instruments for this SOP condition (spondylolisthesis and spondylolysis).
- The spondylolisthesis and spondylolysis instruments at the RMA Website (Page 'S' [5]) will contain the latest SOP Factors.
The following spondylolisthesis and spondylolysis factors were last reviewed for CCPS on 16 September 2011.
A high impact trauma to the spine
Spondylolisthesis and spondylolysis - A high impact trauma to the spine Factor
The RMA has not defined 'a high impact trauma to the spine' in the SOP, however, examples could include:
- a motor vehicle accident
- a diving accident
- a fall from a significant height.
If a veteran or member had a high impact trauma to the spine, significant and immediate medical attention would have been necessary.
Last reviewed for CCPS 16 September 2011.
Investigative Documents
| Type | Title | PDF Format | Word Format |
|---|---|---|---|
| Claimant Report | Trauma - Spondylolisthesis and Spondyloysis |
CR9160.pdf [6] |
 CR9160.docx [7] |
| Medical Report | Trauma - Spondylolisthesis and Spondyloysis |
MR9223.pdf [8] |
MR9223.docx [9] |
Preliminary questions [28742]
28747 the veteran has experienced a high impact trauma to the spine at some time.
35854 the high impact trauma to the spine resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
28748 the veteran has established the causal connection between the high impact trauma to the spine and VEA service for spondylolisthesis or spondylolysis.
28750 the veteran has established the causal connection between the high impact trauma to the spine and VEA service for the clinical onset of cervical spondylolisthesis or spondylolysis.
28753 the veteran has established the causal connection between the high impact trauma to the spine and operational service for the clinical onset of cervical spondylolisthesis or spondylolysis.
or
28754 the veteran has established the causal connection between the high impact trauma to the spine and eligible service for the clinical onset of cervical spondylolisthesis or spondylolysis.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
28752 the veteran has established the causal connection between the high impact trauma to the spine and VEA service for the clinical worsening of cervical spondylolisthesis or spondylolysis.
28755 the veteran has established the causal connection between the high impact trauma to the spine and operational service for the clinical worsening of cervical spondylolisthesis or spondylolysis.
or
28756 the veteran has established the causal connection between the high impact trauma to the spine and eligible service for the clinical worsening of cervical spondylolisthesis or spondylolysis.
Clinical onset and operational service [28753]
35855 on operational service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
35859 on operational service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical onset of the condition under consideration.
35865 the high impact trauma to the spine which the veteran experienced on operational service within the six weeks before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
or
35869 the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration as a consequence of an illness or injury which is identifiable.
35870 as a consequence of the identified illness or injury, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical onset of the condition under consideration.
35872 the identified illness or injury, as a consequence of which the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration, is causally related to operational service.
Clinical onset and eligible service [28754]
35856 on eligible service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
35858 as a causal result of eligible service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
35861 as a causal result of eligible service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical onset of the condition under consideration.
35866 the high impact trauma to the spine which the veteran experienced on eligible service within the six weeks before the clinical onset of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
or
35869 the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration as a consequence of an illness or injury which is identifiable.
35870 as a consequence of the identified illness or injury, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical onset of the condition under consideration.
35873 the identified illness or injury, as a consequence of which the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration, is causally related to eligible service.
Clinical worsening and operational service [28755]
35855 on operational service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
35857 as a causal result of operational service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
35860 as a causal result of operational service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical worsening of the condition under consideration.
35863 the clinical onset of the condition under consideration occurred prior to the veteran experiencing the high impact trauma to the spine on operational service within the six weeks before the clinical worsening of the condition under consideration.
35867 the high impact trauma to the spine which the veteran experienced on operational service within the six weeks before the clinical worsening of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
or
35869 the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration as a consequence of an illness or injury which is identifiable.
35871 as a consequence of the identified illness or injury, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical worsening of the condition under consideration.
35872 the identified illness or injury, as a consequence of which the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration, is causally related to operational service.
35874 the clinical onset of the condition under consideration occurred prior to the operational service to which the identified illness or injury, as a consequence of which the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration, is causally related.
Clinical worsening and eligible service [28756]
35856 on eligible service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
35858 as a causal result of eligible service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration.
35862 as a causal result of eligible service, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical worsening of the condition under consideration.
35864 the clinical onset of the condition under consideration occurred prior to the veteran experiencing the high impact trauma to the spine on eligible service within the six weeks before the clinical worsening of the condition under consideration.
35868 the high impact trauma to the spine which the veteran experienced on eligible service within the six weeks before the clinical worsening of the condition under consideration was due to the veteran's serious default, wilful act or serious breach of discipline.
or
35869 the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration as a consequence of an illness or injury which is identifiable.
35871 as a consequence of the identified illness or injury, the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration within the six weeks before the clinical worsening of the condition under consideration.
35873 the identified illness or injury, as a consequence of which the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration, is causally related to eligible service.
35875 the clinical onset of the condition under consideration occurred prior to the eligible service to which the identified illness or injury, as a consequence of which the veteran experienced a high impact trauma to the spine which resulted in an acute fracture of the vertebral arch or dislocation of the vertebra affected by the condition under consideration, is causally related.
Destructive bone lesion involving the affected vertebra
Spondylolisthesis and spondylolysis - Destructive bone lesion involving the affected vertebra Factor
RMA definition
A destructive bone lesion means 'lytic or erosive lesion of the bone resulting from pathology such as benign and malignant tumours, tuberculosis or osteomyelitis'.
General information
Lesions involving the vertebrae are very rare, but examples include tuberculous spondylitis, giant cell tumours of the vertebral arch, metastatic tumours, neurogenic arthropathies and Paget's disease.
Medical advice will be needed to determine whether the veteran suffered from such a lesion, and to identify the cause of the lesion.
Last reviewed for CCPS 16 September 2011.
Preliminary questions [24407]
29398 there is some evidence that a destructive bone lesion involving the affected vertebra may be a factor in the development or worsening of the condition under consideration.
24352 the veteran has had a destructive bone lesion involving a vertebra at some time.
24353 the destructive bone lesion involved the vertebra affected by the condition under consideration.
24354 the veteran had the destructive bone lesion involving the vertebra affected by the condition under consideration as a result of an illness or injury which is identifiable. [Default true]
24356 the veteran has established the causal connection between the destructive bone lesion and VEA service for spondylolisthesis or spondylolysis.
24366 as a consequence of the identified illness or injury, the veteran had the destructive bone lesion involving the vertebra affected by the condition under consideration at the time of the clinical onset of condition under consideration.
24357 the veteran has established the causal connection between the destructive bone lesion and VEA service for the clinical onset of spondylolisthesis or spondylolysis.
24361 the veteran has established the causal connection between the destructive bone lesion and operational service for the clinical onset of spondylolisthesis or spondylolysis.
or
24362 the veteran has established the causal connection between the destructive bone lesion and eligible service for the clinical onset of spondylolisthesis or spondylolysis.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
24365 as a consequence of the identified illness or injury, the veteran had the destructive bone lesion involving the vertebra affected by the condition under consideration at the time of the clinical worsening of condition under consideration.
24358 the veteran has established the causal connection between the destructive bone lesion and VEA service for the clinical worsening of spondylolisthesis or spondylolysis.
24363 the veteran has established the causal connection between the destructive bone lesion and operational service for the clinical worsening of spondylolisthesis or spondylolysis.
or
24364 the veteran has established the causal connection between the destructive bone lesion and eligible service for the clinical worsening of spondylolisthesis or spondylolysis.
Clinical onset and operational service [24361]
24367 the identified illness or injury which caused the destructive bone lesion involving the vertebra affected by the condition under consideration is causally related to operational service.
Clinical onset and eligible service [24362]
24368 the identified illness or injury which caused the destructive bone lesion involving the vertebra affected by the condition under consideration is causally related to eligible service.
Clinical worsening and operational service [24363]
24367 the identified illness or injury which caused the destructive bone lesion involving the vertebra affected by the condition under consideration is causally related to operational service.
24369 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury which caused the destructive bone lesion involving the vertebra affected by the condition under consideration is causally related.
Clinical worsening and eligible service [24364]
24368 the identified illness or injury which caused the destructive bone lesion involving the vertebra affected by the condition under consideration is causally related to eligible service.
24370 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury which caused the destructive bone lesion involving the vertebra affected by the condition under consideration is causally related.
Engaging in competitive sport
Spondylolisthesis and spondylolysis - Engaging in competitive sport Factor
The RMA has not defined this term, however, the types of sport that meet the factor description – repetitive and forceful hyperextension, torsion or rotation against resistance of the lumbar spine – would include most body contact sports such as rugby and other football codes; fast bowling in cricket; gymnastics; weight lifting; rowing; and javelin throwing. Memberships and affiliations with sporting bodies and clubs would be an expected prerequisite for high level engagement in competitive sports.
Last reviewed for CCPS 16 September 2011.
Investigative Documents
| Type | Title | PDF Format | Word Format |
|---|---|---|---|
| Claimant Report | Engaging in competitive sport |
CR9259.pdf [10] |
CR9259.docx [11] |
Preliminary questions [35846]
35847 there is some evidence that engaging in competitive sport may be a factor in the development of the condition under consideration.
28743 the condition under consideration involves the lumbar spine.
24334 the veteran's spondylolisthesis or spondylolysis is lumbar spondylolytic spondylolisthesis or spondylolysis.
29357 the condition under consideration is lumbar spondylolysis.
35848 the veteran was less than 25 years of age at the time of the clinical onset of the condition under consideration.
35849 the veteran has engaged in competitive sport that requires repetitive and forceful hyperextension, torsion or rotation against resistance of the lumbar spine at some time.
35850 the veteran has established the causal connection between engaging in competitive sport and operational service for the clinical onset of lumbar spondylolytic spondylolisthesis or spondylolysis.
Clinical onset and operational service [35850]
35852 the veteran engaged in competitive sport that requires repetitive and forceful hyperextension, torsion or rotation against resistance of the lumbar spine for an average period of at least 10 hours a week for the six months before the clinical onset of the condition under consideration.
35853 operational service made a material contribution to the veteran engaging in competitive sport that requires repetitive and forceful hyperextension, torsion or rotation against resistance of the lumbar spine for an average period of at least 10 hours a week for the six months before the clinical onset of the condition under consideration.
Lumbar spondylosis affecting the facet joints
Spondylolisthesis and spondylolysis - Lumbar spondylosis affecting the facet joints Factor
Signs and symptoms
Lumbar spondylosis causes lower back pain which may be intermittent and may be aggravated by prolonged sitting or standing. The spine is stiff after immobility and movements are limited and painful. The back pain may spread into the buttocks or legs. There may be acute incidents of "locking" or "giving way".
It is possible for X-ray changes of lumbar spondylosis to exist in the absence of physical symptoms such as pain.
Clinical onset of lumbar spondylosis
Last reviewed for CCPS 16 September 2011.
Preliminary questions [24406]
28743 the condition under consideration involves the lumbar spine.
29610 the condition under consideration is a degenerative lumbar spondylolisthesis.
29359 the condition under consideration is lumbar spondylolisthesis.
29357 the condition under consideration is lumbar spondylolysis.
24343 the veteran has had lumbar spondylosis affecting the facet joints at some time.
24344 the veteran's lumbar spondylosis affected the vertebral facet joints at the level of the vertebra affected by the degenerative lumbar spondylolisthesis.
24345 the veteran had the lumbar spondylosis affecting the vertebral facet joints at the level of the vertebra affected by degenerative lumbar spondylolisthesis before the clinical onset of degenerative lumbar spondylolisthesis.
24347 the veteran has established the causal connection between the lumbar spondylosis affecting the facet joints and VEA service for the clinical onset of degenerative lumbar spondylolisthesis.
24348 the veteran has established the causal connection between the lumbar spondylosis affecting the facet joints and operational service for the clinical onset of degenerative lumbar spondylolisthesis.
or
24349 the veteran has established the causal connection between the lumbar spondylosis affecting the facet joints and eligible service for the clinical onset of degenerative lumbar spondylolisthesis.
Clinical onset and operational service [24348]
24350 the lumbar spondylosis affecting the vertebral facet joints at the level of the vertebra affected by the degenerative lumbar spondylolisthesis is causally related to operational service.
Clinical onset and eligible service [24349]
24351 the lumbar spondylosis affecting the vertebral facet joints at the level of the vertebra affected by the degenerative lumbar spondylolisthesis is causally related to eligible service.
No appropriate clinical management for spondylolysis or spondylolisthesis
Spondylolisthesis and spondylolysis - No appropriate clinical management for spondylolysis or spondylolisthesis Factor
In most cases treatment of spondylolisthesis and spondylolysis will be conservative, will be directed at symptom relief, and will not influence disease progress. Such treatment includes decrease in activities, muscle strengthening exercises, medication and periodic monitoring of symptoms and slippage.
Therefore, in most cases, failure to obtain appropriate clinical management will not result in permanent worsening of the conditions. However in the following cases a lack of treatment could have serious consequences:
- acute traumatic spondylolisthesis or spondylolysis is defined by the RMA to mean 'spondylolisthesis or spondylolysis arising as the direct result of a severe, high energy trauma to the spine'. In such cases the required treatment is a combination of traction and cervical supports [where affecting the cervical spine] or surgical reduction of the slip [in cases affecting the lumbar spine];
- neurological manifestations, such as nerve root entrapment, where surgery is the required treatment, and
- severe progressive symptoms warranting surgical intervention.
The SOP limits the application of the 'inability to obtain appropriate clinical management' factor to these three situations.
Inability to obtain appropriate clinical management
Last reviewed for CCPS 16 September 2011.
Investigative Documents
| Type | Title | PDF Format | Word Format |
|---|---|---|---|
| Medical Report | No appropriate clinical management for spondylolysis or spondylolisthesis |
GQACM.pdf [12] |
GQACM.docx [13] |
Preliminary questions [24398]
24410 the condition under consideration is a type of spondylolisthesis or spondylolysis that may be aggravated by an inability to obtain appropriate clinical management for spondylolisthesis or spondylolysis.
24395 the condition under consideration is acute traumatic spondylolisthesis or spondylolysis.
or
24396 the condition under consideration resulted in neurological manifestations.
or
24397 the condition under consideration resulted in severe progressive symptoms warranting surgical intervention.
11109 the condition under consideration has been accepted on the basis of inability to obtain appropriate clinical management for the condition under consideration.
7066 there is some evidence that an inability to obtain appropriate clinical management for the condition under consideration may be a factor in the worsening of the condition under consideration.
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
7378 the veteran was unable to obtain appropriate clinical management for the condition under consideration at some time.
7379 the inability to obtain appropriate clinical management for the condition under consideration contributed to the clinical worsening of the condition under consideration.
11234 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and VEA service for the clinical worsening of the condition under consideration.
11235 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and operational service for the clinical worsening of the condition under consideration.
or
11236 the veteran has established the causal connection between the inability to obtain appropriate clinical management for the condition under consideration and eligible service for the clinical worsening of the condition under consideration.
Clinical worsening and operational service [11235]
7384 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service.
21084 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during operational service, as a causal result of operational service.
7387 the veteran's inability to obtain appropriate clinical management for the condition under consideration during operational service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7390 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to operational service.
7392 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
Clinical worsening and eligible service [11236]
7385 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service.
7386 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, during eligible service, as a causal result of eligible service.
7388 the veteran's inability to obtain appropriate clinical management for the condition under consideration during eligible service was due to the veteran's serious default, wilful act or serious breach of discipline.
or
7389 the veteran was unable to obtain appropriate clinical management for the condition under consideration, which contributed to the clinical worsening of the condition under consideration, because of an illness or injury which is identifiable.
7391 the identified illness or injury which prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related to eligible service.
7393 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury that prevented the veteran from obtaining appropriate clinical management for the condition under consideration is causally related.
Posterior lumbar spinal decompression surgery
Spondylolisthesis and spondylolysis - Posterior lumbar spinal decompression surgery Factor
RMA definition
A 'surgical procedure involving the removal of the posterior elements of the spine such as laminectomy, laminotomy or facetectomy'.
General information
The posterior elements of the spine refer to the bony structures at the back of the spine and visible in the diagram of lumbar vertebra.
Posterior spinal decompression surgery relates to the removal of bone (by scraping or cutting) and may be undertaken to help release pressure when the bony structures impinge on an intervertebral disc or spinal nerves causing symptoms. It may also be performed in cases where a disc is extensively damaged and the surgeon needs greater access to perform a discectomy. It does not include the more common form of spinal 'keyhole' surgery undertaken for bulging discs as the posterior elements of the spine (bony structures) remain intact in this procedure.
Posterior spinal decompression is a major surgical procedure that would be documented in medical records.
Last reviewed for CCPS 16 September 2011.
Preliminary questions [24404]
29393 there is some evidence that posterior lumbar spinal decompression surgery may be a factor in the development or worsening of the condition under consideration.
28743 the condition under consideration involves the lumbar spine.
24371 the veteran has undergone posterior lumbar spinal decompression surgery at some time.
29394 the veteran underwent posterior lumbar spinal decompression surgery at the level of the vertebrae affected by the condition under consideration.
29395 the veteran underwent posterior lumbar spinal decompression surgery at the level of the vertebrae affected by the condition under consideration for an illness or injury which is identifiable. [Default true]
24375 the veteran has established the causal connection between the posterior lumbar spinal decompression surgery and VEA service for lumbar spondylolisthesis or spondylolysis.
24373 the veteran underwent posterior lumbar spinal decompression surgery for the identified illness or injury before the clinical onset of condition under consideration at that level.
24377 the veteran has established the causal connection between the posterior lumbar spinal decompression surgery and VEA service for the clinical onset of lumbar spondylolisthesis or spondylolysis.
24379 the veteran has established the causal connection between the posterior lumbar spinal decompression surgery and operational service for the clinical onset of lumbar spondylolisthesis or spondylolysis.
or
24382 the veteran has established the causal connection between the posterior lumbar spinal decompression surgery and eligible service for the clinical onset of lumbar spondylolisthesis or spondylolysis.
or
7334 the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.
7335 the condition under consideration permanently worsened.
24374 the veteran underwent posterior lumbar spinal decompression surgery for the identified illness or injury within the 10 years before the clinical worsening of the condition under consideration at that level.
24378 the veteran has established the causal connection between the posterior lumbar spinal decompression surgery and VEA service for the clinical worsening of lumbar spondylolisthesis or spondylolysis.
24380 the veteran has established the causal connection between the posterior lumbar spinal decompression surgery and operational service for the clinical worsening of lumbar spondylolisthesis or spondylolysis.
or
24381 the veteran has established the causal connection between the posterior lumbar spinal decompression surgery and eligible service for the clinical worsening of lumbar spondylolisthesis or spondylolysis.
Clinical onset and operational service [24379]
24383 the identified illness or injury for which the posterior lumbar spinal decompression surgery was undergone is causally related to operational service.
Clinical onset and eligible service [24382]
24384 the identified illness or injury for which the posterior lumbar spinal decompression surgery was undergone is causally related to eligible service.
Clinical worsening and operational service [24380]
24383 the identified illness or injury for which the posterior lumbar spinal decompression surgery was undergone is causally related to operational service.
24385 the clinical onset of the condition under consideration occurred prior to that part of operational service to which the identified illness or injury for which the posterior lumbar spinal decompression surgery was undergone is causally related.
Clinical worsening and eligible service [24381]
24384 the identified illness or injury for which the posterior lumbar spinal decompression surgery was undergone is causally related to eligible service.
24386 the clinical onset of the condition under consideration occurred prior to that part of eligible service to which the identified illness or injury for which the posterior lumbar spinal decompression surgery was undergone is causally related.
Posterior spinal lumbar fusion
Spondylolisthesis and spondylolysis - Rheumatoid arthritis affecting the cervical spine Factor
RMA definition
A 'surgical procedure involving immobilisation of the posterior elements, particularly the spinous processes, of two or more lumbar vertebrae, by the use of bone grafting, in the absence of immobilisation of the lateral elements, particularly the transverse processes, of the same vertebrae. This definition specifically excludes posterolateral lumbar spinal fusion'.
General information
Posterior fusion is a major surgical procedure and would be documented in medical records.
Posterior lumbar spinal fusion is carried out through an incision in the back, as opposed to anterior fusion which is carried out from the front of the patient, and may be indicated in cases of:
- intervertebral disc degeneration, or in conjunction with surgery for removal of a ruptured disc
- prior disc surgery resulting in disc space collapse and persistent pain
- instability associated with a long history of back pain
Posterior lumbar spinal fusion may also be carried out as treatment for spondylolisthesis and spondylolysis.
Last reviewed for CCPS 16 September 2011.
Preliminary questions [24405]
29390 there is some evidence that a posterior lumbar spinal fusion may be a factor in the development of the condition under consideration.
28743 the condition under consideration involves the lumbar spine.
24334 the veteran's spondylolisthesis or spondylolysis is lumbar spondylolytic spondylolisthesis or spondylolysis.
29357 the condition under consideration is lumbar spondylolysis.
24387 the veteran has undergone a posterior lumbar spinal fusion at some time.
24388 the veteran underwent a posterior lumbar spinal fusion of a segment of a vertebra which adjoins a vertebra affected by the lumbar spondylolytic spondylolisthesis or spondylolysis.
24389 the veteran underwent a posterior lumbar spinal fusion of a segment of a vertebra which adjoins a vertebra affected by the lumbar spondylolytic spondylolisthesis or spondylolysis before the clinical onset of lumbar spondylolytic spondylolisthesis or spondylolysis.
29392 the veteran underwent a posterior lumbar spinal fusion of a segment of a vertebra which adjoins a vertebra affected by the lumbar spondylolytic spondylolisthesis or spondylolysis before the clinical onset of lumbar spondylolytic spondylolisthesis or spondylolysis for an illness or injury which is identifiable. [Default true]
24390 the veteran has established the causal connection between the posterior lumbar spinal fusion and VEA service for the clinical onset of the condition under consideration.
24391 the veteran has established the causal connection between the posterior lumbar spinal fusion and operational service for the clinical onset of lumbar spondylolytic spondylolisthesis or spondylolysis.
or
24392 the veteran has established the causal connection between the posterior lumbar spinal fusion and eligible service for the clinical onset of lumbar spondylolytic spondylolisthesis or spondylolysis.
Clinical onset and operational service [24391]
24394 the identified illness or injury for which the posterior lumbar spinal fusion was undergone is causally related to operational service.
Clinical onset and eligible service [24392]
24393 the identified illness or injury for which the posterior lumbar spinal fusion was undergone is causally related to eligible service.
Rheumatoid arthritis affecting the cervical spine
Spondylolisthesis and spondylolysis - Rheumatoid arthritis affecting the cervical spine Factor
Rheumatoid arthritis frequently affects the cervical spine, and there is a range of clinical manifestations. There may be no symptoms, there may be pain, or there may be neurological involvement of varying degrees e.g. parasthesiae and/or weakness. In the most serious form it causes spinal cord compression and paralysis.
Involvement of the cervical spine would be demonstrated by X-rays or other radiological investigation, eg. CT scan, or MRI – usually after the diagnosis of rheumatoid arthritis has been established.
Last reviewed for CCPS 16 September 2011.
Preliminary questions [24408]
29399 there is some evidence that rheumatoid arthritis affecting the cervical spine may be a factor in the development of the condition under consideration.
28741 the condition under consideration involves the cervical spine.
29611 the condition under consideration is a type of cervical spondylolisthesis or spondylolysis that can be caused by rheumatoid arthritis affecting the cervical spine.
28767 the condition under consideration is cervical spondylolisthesis.
24335 the veteran has had rheumatoid arthritis affecting the cervical spine at some time.
24337 the veteran had rheumatoid arthritis affecting the cervical spine at the time of the clinical onset of the condition under consideration.
24338 the veteran has established the causal connection between the rheumatoid arthritis affecting the cervical spine and VEA service for the clinical onset of cervical spondylolisthesis.
24339 the veteran has established the causal connection between the rheumatoid arthritis affecting the cervical spine and operational service for the clinical onset of cervical spondylolisthesis.
or
24340 the veteran has established the causal connection between the rheumatoid arthritis affecting the cervical spine and eligible service for the clinical onset of cervical spondylolisthesis.
Clinical onset and operational service [24339]
29612 the rheumatoid arthritis affecting the cervical spine is causally related to operational service.
Clinical onset and eligible service [24340]
29613 the rheumatoid arthritis affecting the cervical spine is causally related to eligible service.
Links
[1] http://www.rma.gov.au/assets/SOP/2017/024.pdf
[2] http://www.rma.gov.au/assets/SOP/2017/025.pdf
[3] https://clik.dva.gov.au/system/files/media/Bulletin%20195.pdf
[4] https://clik.dva.gov.au/user/login?destination=comment/reply/64146%23comment-form
[5] http://www.rma.gov.au/SOP/alpha_ind/s.htm
[6] https://clik.dva.gov.au/system/files/media/CR9160.pdf
[7] https://clik.dva.gov.au/system/files/media/CR9160.docx
[8] https://clik.dva.gov.au/system/files/media/MR9223.pdf
[9] https://clik.dva.gov.au/system/files/media/MR9223.docx
[10] https://clik.dva.gov.au/system/files/media/CR9259.pdf
[11] https://clik.dva.gov.au/system/files/media/CR9259.docx
[12] https://clik.dva.gov.au/system/files/media/GQACM_13.pdf
[13] https://clik.dva.gov.au/system/files/media/GQACM_13.docx