SNOMED CT Community - Request for feedback for: Spinal dislocation/subluxation with cord lesion concepts

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.
Please provide feedback by 17th February as to whether replacement is warranted, or they should just be removed from the terminology.