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Condition/Disorder Synonyms

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  • Spinal osteoarthritis

  • Cervical spondylosis

  • Thoracic spondylosis

  • Lumbar spondylosis

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ICD-9-CM Codes

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  • 721 Spondylosis and allied disorders

  • 721.0 Cervical spondylosis without myelopathy

  • 721.1 Cervical spondylosis with myelopathy

  • 721.2 Thoracic spondylosis without myelopathy

  • 721.3 Lumbosacral spondylosis without myelopathy

  • 721.4 Thoracic or lumbar spondylosis with myelopathy

  • 721.41 Spondylosis with myelopathy, thoracic region

  • 721.42 Spondylosis with myelopathy, lumbar region

  • 721.9 Spondylosis of unspecified site

  • 721.90 Spondylosis of unspecified site, without myelopathy

  • 721.91 Spondylosis of unspecified site, with myelopathy

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ICD-10-CM Codes

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  • M47.12 Other spondylosis with myelopathy, cervical region

  • M47.14 Other spondylosis with myelopathy, thoracic region

  • M47.16 Other spondylosis with myelopathy, lumbar region

  • M47.812 Spondylosis without myelopathy or radiculopathy, cervical region

  • M47.814 Spondylosis without myelopathy or radiculopathy, thoracic region

  • M47.817 Spondylosis without myelopathy or radiculopathy, lumbosacral region

  • M47.819Spondylosis without myelopathy or radiculopathy, site unspecified

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Preferred Practice Patterns1

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Key Features

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Description

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  • Osteoarthritis of the spine

  • Chronic degeneration

  • Progressive arthritis of the spinal joints

  • As the space between the vertebrae decreases, there can be compression onto the nerve roots

  • Arthritis can be central or lateral foramen based

    • Central: usually bilateral symptoms

    • Lateral: usually unilateral

  • Pain, paresthesia, and weakness in the extremities

  • Pressure on the nerve root can cause radiculopathy.

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Essentials of Diagnosis

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  • X-ray

  • Acute painful flare-ups, chronic persistent pain

  • Relief with NSAIDs

  • Morning stiffness

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General Considerations

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  • Begins with pain that is intermittent

  • Pain and stiffness at rest/sleep

  • Improved with low-level activity

  • Could have rapid and severe onset

  • Secondary problem is vertebrobasilar insufficiency

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Demographics

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  • Common in adults ages 60 and older

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Clinical Findings

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Signs and Symptoms

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  • Fatigue

  • Stiffness

  • Heaviness

  • Loss of ROM and joint play

  • Pain that is intermittent, increased with weight-bearing activities

  • Paresthesia

  • Tingling sensation in the extremity

  • Diminished reflexes

  • Lower motor neuron dysfunction

  • Muscle weakness

  • Radiculopathy

  • Characteristics of the different syndromes of cervical spondylotic myelopathy

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Functional Implications

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  • Limited mobility

  • Increased symptoms with increased weight-bearing exercises

  • Aerobic endurance limitation

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Possible Contributing Causes

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  • Family history of osteoarthritis

  • Bone spurs

  • Instability

  • Weakness

  • Poor posture

  • Limited flexibility

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Differential Diagnosis

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  • Spinal stenosis

  • Disc herniation

  • Forestier disease

  • Reiter's syndrome (reactive arthritis)

  • Whipple's disease

  • Yersinia arthritis

  • Facet joint arthritis

  • Psoriatic arthritis

  • Rheumatoid arthritis

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Means of Confirmation or Diagnosis

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Imaging

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  • X-ray spine and pelvis

  • MRI of the spine

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Findings and Interpretation

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