Summary
There are three primitive subhierarchies under 263013004 |Dislocation of joint of spine (disorder)|:
- 312837005 |Spinal dislocation with cervical cord lesion (disorder)|
- 312839008 |Spinal dislocation with lumbar cord lesion (disorder)|
- 312838000 |Spinal dislocation with thoracic cord lesion (disorder)|
All of these have multiple primitive subtypes representing open and closed cord lesions of varying types, totaling 27 concepts.
Similarly, there are four additional primitive subhierarchies under 263039001 |Subluxation of joint of spine (disorder)|:
- 312792007 |Spinal subluxation with cauda equina lesion (disorder)|
- 312786001 |Spinal subluxation with cervical cord lesion (disorder)|
- 312788000 |Spinal subluxation with lumbar cord lesion (disorder)|
- 312787005 |Spinal subluxation with thoracic cord lesion (disorder)|
These also have primitive subtypes for a total of 36 concepts. All of these concepts have effective dates of 20020131 and the source of these terms is unclear.
In the course of the quality improvement project, these concepts were evaluated for remodeling. They are all currently modeled with a finding site of 8983005 |Joint structure of spine (body structure)| in line with the FSN, which does not imply the location of the dislocation/subluxation in the spine. This has led to the suggestion that these terms either represent a co-occurrent pre-coordinated term (i.e. dislocation of spine and spinal cord lesion, not necessarily in the same location on the spine), or implies that the dislocation and cord injury are at the same position, making the FSN vague and open to interpretation. The former condition of co-occurrence is no longer accepted in the international release and the latter condition would warrant inactivation and possible replacement with more specific concepts representing the co-location of the injury.
SNOMED International would like to inactivate these terms due to the inherent problems as stated above. We would like input from the CMAG as to whether replacement is warranted, or they should just be removed from the terminology.
Respectfully,
James T. Case DVM, PhD, FACMI
Head of Terminology
Relevant documents
Actions
| Date | Requested action | Requester(s) | Response required by: | Comments |
|---|---|---|---|---|
| 30 Jan 2020 | Feedback on spinal dislocation/ subluxation with cord lesion replacement requirements |
| Please post your final responses in the Country response table below. Discussion comments can be made as comments. |
Links
Country response
| Country | Date | Response |
|---|---|---|
| Denmark | 20200130 | Concepts are not in use in Denmark, so no objections to clean up. |
| The Netherlands | 20200130 | The above mentioned concepts are not used in our diagnoses list. We do have some concepts that are subtypes like 'Spinal dislocation with complete cervical cord lesion (disorder)'. But I rather remodel them to be fully defined. So I totally agree with cleaning up that area! |
| US | 20200130 | No evidence of use of these codes in any value sets from VSAC. Interestingly, no evidence of use in relevant value sets, such as "Spinal Cord Injury", where many other codes are used. |
| Norway | 20200204 | We agree that these concepts should be inactivated. However, replacement concepts are needed. We propose not to precoordinate dislocation/subluxation concepts with the actual injury concepts. The word "lesion" seems to be very broad in meaning in English so in any case one could imagine the need to document more detailed what the actual injury is. Such concepts may exist already in SNOMED CT. For the dislocation/subluxation concepts we propose detailed concepts on the level of Cn-Tn-Ln, perhaps grouped into cervical, thoracic, lumbar.. 90584004 |Spinal cord injury (disorder)|with children will document any spinal cord injury when needed. |
| Australia | 20200205 | We're not aware of any usage (though don't have huge visibility). However, the few stakeholders I got feedback from agreed the "lesion" referred to in these concepts would (by rational logic) be in the same location as the dislocation, ie the dislocation caused the lesion. Could also indicate the severity of the dislocation or potential likely hood of certain consequences (e.g. ~90% of dislocations above T10 result in complete paraplegia and ~60% below T10 result in complete paraplegia). I agree with the comment above about the broad meaning of "lesion". 19130008 | Traumatic abnormality (morphologic abnormality) | is would be a better morphology. Given the assumptions I've made.. the concepts probably are ambiguous. |
| Belgium | 20200221 | We're not aware of the use of these concepts in Belgium at this moment. We agree with cleaning them up |
| Member countries without a CMAG rep |
CMAG response
| Date | CMAG Response | Next steps |
|---|---|---|
Final outcome:
Date:
2 Comments
Theresa Barry
Ireland, concepts not in use in Ireland.
Theresa Barry
Ireland, replacement should probably be considered for this content.