Spinal fusion refers to the joining together of two or more spinal vertebrae. It results in decreased spinal flexibility.

Spinal fusion can result from a surgical procedure that uses a bone graft or internal device, such as metal rods, to treat a medical condition resulting in spinal instability. However, spinal fusion as a diagnosis refers to a complication of other spinal conditions, such as, ankylosing spondylitis (see Diagnostic Code: 5240), or degenerative arthritis of the spine (see Diagnostic Code: 5242).

Signs and symptoms of spinal fusion due to other spinal conditions include: pain and stiffness in the lower back; limitation of motion of the spine; and deformity as the condition progresses.

If spinal fusion occurs as a result of other spinal conditions, complete medical history and physical examination will be needed to diagnose the condition. Diagnostic tests would most likely include: spine x-rays; computed tomography (CT) scans; or magnetic resonance imaging (MRI) scans. Blood tests may also be necessary to confirm the diagnosis of other conditions that are resulting in fusion of the spine.

The goal of treatment for spinal fusion is to relieve pain and stiffness, and prevent, delay, or correct spinal deformity. Treatments may include: Non-steroidal anti-inflammatory drugs (NSAIDs); and physical or rehabilitation therapy and exercise to maintain spinal mobility and maintain or improve posture.

Even with appropriate treatment of spinal fusion, permanent posture and mobility losses may occur. Residuals will depend on the severity of the condition, the timeliness and effectiveness of treatments, and the individual's body response to the condition and treatments. Activities may be limited based on the severity of symptoms, and residuals can vary from zero disability to total disability, e.g., complete rigidity or fixation of the spine. Spinal fusion decreases the movement between the fused vertebrae, which can put added strain on the vertebrae above and below the fusion. This has some potential to accelerate degeneration of those segments.

• 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.