Degenerative arthritis of the spine is primarily a disorder of cartilage and the bone underlying the cartilage of the spinal column or vertebral column, which encompasses the cervical, thoracic, lumbar, and sacral vertebrae. All tissues in and around involved joints are enlarged (hypertrophic). The condition is noted by marked deterioration in synovial joints and vertebrae, which causes the cartilage to rub together, causing pain, swelling and loss of motion of the joint. The condition is non-inflammatory. Osteoarthritis (OA) (see Diagnostic Code: 5003) is the most common form of degenerative arthritis affecting the spine. Other types of arthritis of the spine include ankylosing spondylitis (see Diagnostic Code: 5240) and rheumatoid arthritis (see Diagnostic Code: 5002), which is an autoimmune condition that affects the synovium initially and secondarily affects the cartilage.

The cause is unknown. The condition may be from a singular event or combination of events or causes to include: genetic defects; infection; metabolic, endocrine, and neuropathic disease; acute trauma (fracture); chronic trauma (prolonged overuse of a joint through occupation, or sports, etc.); and anything that causes damage to the cartilage. Risk factors associated with the condition include aging, obesity, overuse or abuse of a joint as in sports or strenuous occupations, and trauma.

The signs and symptoms of degenerative arthritis include: back or neck pain and stiffness relieved by rest; brief periods of spinal stiffness in the morning that later develops into pain on motion; limited range of motion with difficulty bending or walking; flexion contracture; weakness or numbness in the legs or arms; tenderness; crepitus; joint enlargement; spinal deformity; and incomplete or partial dislocation of a joint.

Cartilage loss or osteophyte formation from osteoarthritis contributes to an individual's pain. Pain of spinal origin radiates to other areas of the lower body such as the buttocks, legs, groin, or thighs depending on the location of the spinal problem. Radicular pain is usually sharp and radiates from the lumbar region to the leg. Coughing, sneezing, lifting heavy objects or straining with bowel movements is common with radicular pain.

To diagnose this condition, a complete medical history and a thorough physical examination will be performed. Diagnostic tests for this condition would most likely include: spine x-ray; computed tomography (CT) scans; magnetic resonance imaging (MRI) scans; a bone scan; and a myelogram. Ankylosis is rare, but there may be hyperostosis and irregular notched articular surfaces of the joints. Diagnostic features include: destruction of cartilage and bone; and changes in bone involving hardening (eburnation), and the formation of osteophytes. Blood tests may also be done to help determine the type of arthritis.

There is no cure for degenerative arthritis of the spine. Treatment is supportive, and may include: rehabilitation; nonsteroidal anti-inflammatory drugs (NSAIDs); muscle relaxants; intra-articular corticosteroids; analgesics; tricyclic antidepressants; physical therapy; exercise balanced with rest; heat/cold therapy; weight reduction and education. In some cases, surgery, such as a total hip replacement, may be necessary. Additional surgical treatments include cartilage tissue grafting, osteotomy, or realignment of the leg and arthrodesis as a salvage procedure.

Residuals depend on the severity of the condition, the timeliness and effectiveness of treatments, and the individual's body response to the disease and treatments. Activities may be limited based on the severity of symptoms. Residuals can vary from zero disability to total disability, e.g., complete rigidity or fixation of spine and both hips.

• 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.

• A diagnosis of arthritis is subject to service connection under 38 CFR 3.309(a) if manifested to a compensable degree within the applicable time limits under 38 CFR 3.307.

• 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.