Spinal stenosis is a narrowing of the spaces in the spinal canal due to degenerative or traumatic changes in the lumbar spine, which may result in pressure on the spinal cord and/or nerve roots.

Narrowing of the spinal canal may be inherited, as in achondroplasia such as a small spinal canal or a curvature of the spine; may be due to aging or acquired conditions, such as degenerative conditions, rheumatoid arthritis (see Diagnostic Code: 5002), or non-arthritic acquired spinal stenosis (tumors, trauma, post-surgical swelling, and infection). Men and women in the seventh and eighth decades of life are the group primarily affected by degenerative spinal stenosis.

Signs and symptoms of the condition include low back pain that may radiate down the leg or legs (sciatica); numbness, tingling, weakness, cramping; abnormal bowel and bladder function; and foot disorders. Usually the pain is aggravated by walking or extension of the spine with relief of symptoms by forward flexion or sitting.

Diagnostic tests for the condition would most likely include: medical history; physical examination with thorough vascular examination, including pulse checks, which may help differentiate vascular claudication from spinal stenosis. Other tests include spinal x-rays; computed tomography (CT) scan; magnetic resonance imaging (MRI); myelogram; or bone scan.

Conservative treatments for spinal stenosis may include changes in posture; restricted activity; non-steroidal, anti-inflammatory medications; analgesics; corticosteroid injections; physical therapy and/or prescribed exercises; and a lumbar brace or corset to provide support. If conservative treatments do not relieve the pain and pressure on the spinal cord or nerves, surgical treatment may be recommended to widen the spinal canal. About 70% to 85% of patients have good results from this procedure.

Removal of the obstruction that has caused symptoms usually gives patients some relief. However, regardless of treatment, if nerves were badly damaged, there may be some residual pain or numbness.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• Evaluate under the General Rating Formula for Diseases and Injuries of the Spine for diagnostic codes 5235 to 5243 unless 5243 is evaluated under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes.

• Evaluate any associated objective neurologic abnormalities, including, but not limited to, bowel or bladder impairment, separately, under an appropriate diagnostic code.

• For VA compensation purposes, normal forward flexion of the cervical spine is zero to 45 degrees (see forward flexion-cervical spine), extension is zero to 45 degrees (see extension-cervical spine), left and right lateral flexion are zero to 45 degrees (see lateral flexion-cervical spine), and left and right lateral rotation are zero to 80 degrees (see lateral rotation-cervical spine). Normal forward flexion of the thoracolumbar spine is zero to 90 degrees , extension is zero to 30 degrees (see forward flexion-thoracolumbar), left and right lateral flexion are zero to 30 degrees (see lateral flexion-thoracolumbar), and left and right lateral rotation are zero to 30 degrees (see lateral rotation-thoracolumbar spine.) The combined range of motion refers to the sum of the range of forward flexion, extension, left and right lateral flexion, and left and right rotation. The normal combined range of motion of the cervical spine is 340 degrees and of the thoracolumbar spine is 240 degrees. The normal ranges of motion for each component of spinal motion provided in this note are the maximum that can be used for calculation of the combined range of motion.

• In exceptional cases, an examiner may state that because of age, body habitus, neurologic disease, or other factors not the result of disease or injury of the spine, the range of motion of the spine in a particular individual should be considered normal for that individual, even though it does not conform to the normal range of motion stated in Note (2). Provided that the examiner supplies an explanation, the examiner's assessment that the range of motion is normal for that individual will be accepted.

• Round each range of motion measurement to the nearest five degrees.

• For VA compensation purposes, unfavorable ankylosis is a condition in which the entire cervical spine, the entire thoracolumbar spine, or the entire spine is fixed in flexion or extension, and the ankylosis results in one or more of the following: difficulty walking because of a limited line of vision; restricted opening of the mouth and chewing; breathing limited to diaphragmatic respiration; gastrointestinal symptoms due to pressure of the costal margin on the abdomen; dyspnea or dysphagia; atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis.

• Separately evaluate disability of the thoracolumbar and cervical spine segments, except when there is unfavorable ankylosis of both segments, which will be rated as a single disability.