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Specialty organizations revise 2001 document to set definitions in spine field

NASS, ASNR and ASSR hope surgeons and nonoperative medical personnel will concur on spinal nomenclature for lumbar disc disease.

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Representatives from the North American Spine Society, American Society of Spine Radiology and American Society of Neuroradiology worked together to set universally accepted definitions for common spine conditions when they recently revised a landmark document published in 2001.

Eugene J. Carragee, MD, editor in chief of The Spine Journal, said in a press release from the North American Spine Society (NASS) the revised document represents the recommendations of the combined task forces of three major specialty societies.

Eugene J. Carragee

“Many people use these terms overlappingly, or disagree about terms and say one means one thing and the other means another. This is an attempt to get together radiologists, orthopedic surgeon and neurosurgeons, and physiatrists who deal with spinal issues to agree to a consensus when certain things are said under certain headings, such as disc herniation, and be on the same page,” Carragee told Spine Surgery Today.

On the same page

The new document, “Lumbar Disc Nomenclature: Version 2.0, Recommendations of the combined task forces of the North American Spine Society, the American Society of Spine Radiology and the American Society of Neuroradiology,” is a revision of a 2001 document. The revised document was published in The Spine Journal in the November 2014 print and online editions and online in Spine. The American Journal of Neuroradiology will also provide a link to the document.

“While the past 13 years have brought a deeper evidence-based understanding of how to diagnose and treat spine disorders, that information can be ineffective until all spine and radiology professionals are speaking the same language,” Carragee stated in a NASS press release on the subject. “By undertaking this arduous process and creating this universal language, these dedicated spine and radiology professionals will help millions of patients worldwide get appropriate and timely treatment.”

This is the second iteration of the document to bring everyone under the same nomenclature, according to Carragee.

Worldwide definitions needed

To complete the new document, task force members individually and collectively reviewed the literature and revised and updated the original 2001 document, Carragee said in the interview with Spine Surgery Today. The new document was then submitted for review to the editorial boards of The Spine Journal, the official journal of NASS, the American Society of Spine Radiology and the American Society of Neuroradiology.

The document now offers detailed discussions of the imaging diagnostic categories and subcategories and their implications for diagnosing lumbar disc disease. It also includes various terms and definitions in a new glossary, he said.

“Hopefully this will save people time and exposure to radiation, repeat studies, and things like that. That is what we are trying to do here, make a consensus of the nomenclature, whether you agree with it or not,” Carragee told Spine Surgery Today. It will hopefully also reduce patients from getting costly and extensive tests repeated if they go to another doctor or specialist, he said.

Carragee explained if physicians know exactly what the universal definition of a spine disorder means, they can avoid these types of repeat procedures. For instance, if someone has type 2 diabetes, a physician has a concrete definition of what that means. However, for something like a disc herniation, it can mean a number of different things.

“It is a problem for us, say, if someone moves from A to B and they have this kind of a spine problem, and their doctor has them get additional MRI, an X-ray, a CT scan because the diagnosis was unclear. You are giving someone a lot of radiation and a lot of expense,” he said. “Where if they each just knew what they were talking about, you could avoid that. That is the purpose and hopefully the outcome of this second round.”

David F. Fardon, MD, former NASS president and lead author of the new document, stated in the NASS press release, “While the primary focus of this document is to promote clear and consistent communication between clinicians and radiologists, it also has important implications for patients, family members, employers, insurers, researchers and others. When patients and their families understand and have confidence in a universally recognized diagnosis, including the medical terminology, they are able to actively participate in treatment decisions.” – by Robert Linnehan