Comparison between two anatomic landmarks using ultrasonography in spinal anesthesia: a randomized controlled trial

Öztürk, İbrahim; Kiliç, Bülent; Demiroğlu, Murat; Alptekin, Hüseyin Alp; Aydın, Gülümser; Yazicioglu, Dilek; Oğuz, Eylem; Yılmaz, Habip

doi:10.1080/03007995.2016.1203767

Cited by 4 publications

(11 citation statements)

References 8 publications

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“…In the present study, the accuracy of Tuffier line was 59%, consistent with previous studies showing its accuracy of 60% to 64% in general population. [7,9] The accuracy of the 10th rib line was 57%, which was lower than the result in a previous study where showed the 74% accuracy of the 10th rib line. [7] In that study, they compared Tuffier line and the 10th rib line to predict the L4-L5 intervertebral space in young and healthy population, and showed that the 10th rib line is more accurate than Tuffier line (74% vs 60%, respectively).…”

Section: Discussioncontrasting

confidence: 70%

“…[7,9] The accuracy of the 10th rib line was 57%, which was lower than the result in a previous study where showed the 74% accuracy of the 10th rib line. [7] In that study, they compared Tuffier line and the 10th rib line to predict the L4-L5 intervertebral space in young and healthy population, and showed that the 10th rib line is more accurate than Tuffier line (74% vs 60%, respectively). With the 10th rib line, the L4-L5 intervertebral space is determined by counting down the level from the 10th rib line that corresponds to the L1-L2 intervertebral space or the body of L2.…”

Section: Discussionmentioning

confidence: 71%

“…According to the previous studies, [4,7,10] the wrong identified intervertebral level was mostly the higher level with Tuffier and the lower level with the 10th rib line. In our study, the wrong estimation ratio related to the intervertebral level was not different between the 2 landmarks; 1 upper level (L3–L4 intervertebral space, 27% vs 24%, Tuffier line vs the 10th rib line, respectively) and 1 lower level (L5–S1 intervertebral space, 9% vs 16%).…”

Section: Discussionmentioning

confidence: 99%

“…The accuracy, based on a previous study in general patient population, was 74% in the 10th rib-guided approach. [7] A power analysis was performed based on the difference between the 59% and 74% in the accuracy rate, and 76 patients were required at a significance level of 95% and with a power of 80%. Considering the possible dropouts, 84 patients were enrolled.…”

Section: Methodsmentioning

confidence: 99%

“…A previous study showed that the 10th rib line is more accurate to predict the intervertebral level with palpation than Tuffier line. [7]…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…A previous study showed that the 10th rib line is more accurate to predict the intervertebral level with palpation than Tuffier line. [7]…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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Ultrasound-Assisted Spinal Anesthesia in a Patient with a Preexisting Lumbar Interspinous Spacer: A Case Report

Huang,

Singleton,

Qiao

2024

A&A Practice

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An interspinous spacer is a minimally invasive implantable device for the treatment of lumbar spinal stenosis. The in situ implant may prevent safe and successful spinal anesthesia because its position can obstruct the path of the spinal needle. Lumbar neuraxial ultrasonography has been shown to aid in performance of neuraxial anesthesia in patients with challenging anatomy. Currently, there are no reported cases of ultrasound-assisted spinal anesthesia in patients with interspinous spacers. We present a case in which ultrasonography assisted the successful administration of a spinal anesthetic by avoiding an indwelling lumbar interspinous spacer.

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Determining Tuffier’s Line by Ultrasound in Pregnant and Non-pregnant Female Patients: a prospective cohort study

Pırbudak,

Seker,

Mendes

et al. 2023

Bangladesh J Med Sci

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Objectives: The correct determination of the vertebral level is important in anesthesia management and the prevention of possible risks. It has been shown that estimation of L4/5 intervertebral lumbar level based on Tuffier’s line determined by palpation (palpated L4/5) is often inaccurate. In this study, it was aimed to investigate how Tuffier’s line changes in the lateral decubitus position due to pregnancy. Material and Methods: The patients were divided into two groups in this prospective cohort study. The pregnant patients were assigned to Group P (n = 75) while the non-pregnant patients were assigned to Group NP (n = 60). Lumbar ultrasound was conducted in both groups in the left lateral decubitus position to verify the vertebral level determined by Tuffier’s line that was detected by palpation. Demographic data, determination time of Tuffier’s line, ultrasound, and the detected vertebral levels were recorded in both groups. Results and Discussion: Vertebral levels detected by both techniques were compatible with 35 (46.6%) patients in Group P and 36 (60%) patients in Group NP (p = 0.165). The vertebral levels in Group P detected via ultrasound were determined at L2 in three (4%) patients, at L2/3 in three (4%) patients, at L3 intervals in three (4%) patients, and at the L3/4 interval in 31 (41.3%) patients. The vertebral levels of the patients in Group NP detected via ultrasound was at L2/3 in 2 (3.3%) patients, and at the L3/4 interval in 22 (36.7%) patients. For the risk of insertion from a risky injection site, the OR = 3.96–95 and GA = 0.82–19.05 in Group P were higher compared to Group NP (approximately 4 times higher). While Group P was significantly limited in the risk analysis, according to L3 (p = 0.087), the risk under this level was similar (p = 0.124). In this study, the verification of Tuffier’s line determined through palpation did not show the correct vertebral level in almost half of the patients in the lateral decubitus position, regardless of pregnancy and demographic data. Conclusion: We believe a possible spinal cord injury can be prevented by determining the needle insertion site via lumbar ultrasound in the pregnant patients. Bangladesh Journal of Medical Science Vol. 22 No. 03 July’23 Page : 529-535

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Comparison between two anatomic landmarks using ultrasonography in spinal anesthesia: a randomized controlled trial

Abstract: We conclude that the tenth rib line is better than Tuffier's line for accuracy with palpation. However, it must be confirmed by further studies including more than one examiner for palpation and also include different patient populations.

Cited by 4 publications

References 8 publications

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

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

Ultrasound-Assisted Spinal Anesthesia in a Patient with a Preexisting Lumbar Interspinous Spacer: A Case Report

Determining Tuffier’s Line by Ultrasound in Pregnant and Non-pregnant Female Patients: a prospective cohort study

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