Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

Lin, Nan; Li, Yan; Bebawy, John F.; Dong, Jing; Hua, Lin

doi:10.1186/1471-2253-15-9

Cited by 11 publications

(13 citation statements)

References 21 publications

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“…Experience with adults in a dedicated LP clinic recently documented high BMI, female sex and older age as factors associated to an unsuccessful LP, whereas younger age, female sex and hypertension were associated to post-lumbar puncture headache 6 . In another report including 52 adult patients, an abdominal circumference greater than 94 cm or a BMI greater than 26 were associated with greater difficulty in the identification of the intervertebral space and in performing a LP 7 . Overweight and age were also identified as predictors of greater difficulty when carrying out LP in patients with a BMI >30 and age >65 years 8 .…”

Section: Introductionmentioning

confidence: 94%

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Jaime‐Pérez

Sotomayor-Duque

Aguilar-Calderón

et al. 2019

IJHOSCR

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Background: Lumbar puncture (LP) is a hematology procedure that can require repeated attempts leading to traumatic LP (TLP), which has been related to the central nervous system (CNS) relapse. LP success can depend on the size and anatomy of the patient and the skill of the hematologist. The main objective was to determine the influence of body mass index (BMI) on LP outcomes. Materials and Methods: Adults with lymphoid malignancies requiring LP were included prospectively over one year; hematology residents performed most procedures. A 22-gauge Quincke needle was employed. Comparison between non-traumatic vs. traumatic LPs according to BMI, CNS relapse, and residents’ year was performed. Results: Fifty-four patients with a mean age of 31.5±15.57 years were included. Diagnosis was Acute Lymphoblastic Leukemia-B (74%), Acute Lymphoblastic Leukemia-T (13%) and Non-Hodgkin Lymphoma (13%). 227 LPs were performed, 121 (53.3%) successful, 98 (43.2%) traumatic, 11 (11.2%) TLPs were macroscopically detectable and 87 (88%) microscopic; 8 (3.5%) were dry-taps. Median time between punctures was 11 days (1-202). Median BMI was 25 (22.8-39.6). Main indication for LP was prophylactic (74.5%); 39.2% were performed by first-year, 35.2% by second-year, 19.6% by third-year hematology residents. No difference (p = 0.145) for a TLP was found among residents. A BMI ≥30 (p = 0.040), non-palpable intervertebral space (p = 0.001) and more than one attempt (p = 0.001) were significant for TLP. TLP was not associated with CNS relapse (p = 0.962). Conclusion: Obesity predicted a TLP. A traumatic puncture did not increase the risk of CNS relapse at one-year follow-up.

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Section: Introductionmentioning

confidence: 94%

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Jaime‐Pérez

Sotomayor-Duque

Aguilar-Calderón

et al. 2019

IJHOSCR

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“…The palpation and US were both performed in lateral position with lumbar flexion whereas the chest X-ray was taken in the supine position with no flexion at lumbar spine. [ 12 ]…”

Section: Discussionmentioning

confidence: 99%

Accuracy of ultrasound imaging versus manual palpation for locating the intervertebral level

Ambulkar

Patil

Doctor

et al. 2017

J Anaesthesiol Clin Pharmacol

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Background and Aims:Efficacy of epidural analgesia depends on placement of the epidural catheter at the appropriate level. Manual palpation using surface landmarks to identify the desired intervertebral level may not be a reliable method. Ultrasonography (USG) is an alternative technique but requires training and may increase procedure time. The objective of this study was to compare the accuracy of ultrasound (US) imaging with manual palpation for locating the intervertebral level.Material and Methods:We included postoperative adult patients without an epidural catheter who were scheduled to have a chest radiograph in the recovery room. A radio-opaque marker was placed at random at an intervertebral space along the thoracic or lumbar spine of the patient (in the field of the chest radiograph). The level of intervertebral space corresponding to the radio-opaque marker was determined by palpation technique by one anesthetist. Two other anesthetists (A and B) blinded to the result of manual palpation, independently used USG to determine the level of intervertebral space. A consultant radiologist assessed the radiographs to determine the correct position of the marker, which was judged to be the accurate space.Results:We recruited a total of 71 patients, of which 64 patients were included in the final analysis. Accurate identification by manual method was 31/64 (48%), by US A was 27/64 (42%) and by US B was 22/64 (34%). The difference in accuracy between manual palpation and US imaging was not statistically significant (P = 0.71).Conclusion:US imaging may not be superior to manual palpation for identifying intervertebral level.

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“…However, several factors such as patient's age, sex, or body shape could change the location of Tuffier line. [2–5] Thus, the line could be drawn on the wrong points of vertebral level. Another landmark is based on the 10th rib under the assumption that the extended line passes through the L1-L2 intervertebral space or the body of L2.…”

Section: Introductionmentioning

confidence: 99%

Ultrasound assessment of the anatomic landmarks for spinal anesthesia in elderly patients with hip fracture

et al. 2019

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Tuffier line is a common landmark for spinal anesthesia. The 10th rib line has been suggested as a new landmark to predict the intervertebral levels. We evaluated the accuracy of these 2 anatomic landmarks for identifying the L4-L5 intervertebral space using ultrasonography in elderly patients with hip fracture. Seventy-nine elderly patients scheduled for hip fracture surgery under spinal anesthesia were included. In the lateral decubitus position with the fracture side up, the L4-L5 intervertebral space was identified alternately using Tuffier line, a line drawn between the highest points of both iliac crests, and the 10th rib line. The 10th rib line, an imaginary line that joints the 2 lowest points of the rib cage, passes through the L1-L2 intervertebral space or the body of L2. The L4-L5 intervertebral space was determined by the counting-down method from the 10th rib line. Then, the estimated intervertebral spaces were evaluated using ultrasonography. The L4-L5 intervertebral space was correctly identified in 47 (59%) patients with Tuffier line and 45 (57%) patients with the 10th rib line ( P = .87). The estimation ratio related to the intervertebral levels was not different between the 2 landmarks ( P = .40). The wrong identifications of intervertebral level with Tuffier line and the 10th rib line was observed in the following order: L3-L4 intervertebral space: 27% vs 24%, L5-S1 intervertebral space: 9% vs 16%, and L2-L3 intervertebral space: 5% vs 3%, respectively. Tuffier line and the 10th rib line may be unreliable to estimate the intervertebral space for spinal anesthesia in elderly patients with hip fracture.

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Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

Cited by 11 publications

References 21 publications

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Impact of Obesity on Lumbar Puncture Outcomes in Adults with Acute Lymphoblastic Leukemia and Lymphoma: Experience at an Academic Reference Center

Accuracy of ultrasound imaging versus manual palpation for locating the intervertebral level

Ultrasound assessment of the anatomic landmarks for spinal anesthesia in elderly patients with hip fracture

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