Spinal cord termination in adult Africans: Relationship with intercristal line and the transumbilical plane

Abstract

The level of cord termination and level of vertebral intersection of intercristal line and transumbilical plane (TUP), frequently used landmarks, show ethnic variation. The relationship of the spinal cord termination to these lines is vital in spinal surgery and anesthesia, but data on these parameters are scarce in the African population. The purpose of this work is to determine the level of cord termination and establish its relationship with intercristal line and TUP. One hundred and twelve specimens obtained from the department of Human Anatomy at the University of Nairobi were used in this study. The conus medullaris was exposed by laminectomy and its vertebral level together with those of intercristal line and TUP recorded. The distance of conus medullaris from intercristal plane was measured in millimeters. Data obtained were coded and analyzed using Statistical Package for Social Sciences (SPSS) for windows version 16.0 Chicago, Illinois, 2002. Student's t-test was used in the statistical assessment of gender differences. A P value of less than 0.05 was considered significant. The median level of termination of the cord was the upper third of L2, 51.9% of cases terminating below this. There was no statistically significant gender difference in the level of termination of the cord. The intercristal plane passed through L4/L5 disc (70.9%) and below (29.1%). The TUP corresponded with intercristal line in 78.2% of subjects. The mean distance of the spinal cord termination from intercristal line was 99 +/- 24 mm. The spinal cord terminates at or below the upper third of L2. Care should be exercised during lumbar punctures and spinal epidural anesthesia among Africans. Intecristal line and TUP are safe landmarks to use in location of conus medullaris.

Inconsistencies in surface anatomy: The need for an evidence‐based reappraisal

“…A radiographic study in 450 European adult patients showed that the line crossed the body of L4 or the L4/5 intervertebral disc in 72% of cases (Walsh et al, 2006). These findings support a previous radiographic study of 163 patients in which the figure was 79% (Render, 1996) and are similar to subsequent smaller radiographic studies of European (Chakraverty et al, 2007) and American (McGaugh et al, 2007) adults, and a dissection study of African cadavers (Gatonga et al, 2010). The equivalent figure determined by radiography in 72 Korean adults was 64% (Kim et al, 2007), but it is difficult to know whether this is a true ethnic difference.…”

“…The latter was also confirmed in a recent study of 112 adult cadavers in Kenya (Gatonga et al, 2010). Two of these studies also found that the dural sac terminates at S2 in about two thirds of individuals but may be higher or lower (Macdonald et al, 1999;Soleiman et al, 2005).…”

Relationship Between the Levels of Normal Conus Medullaris and Body Mass Index in the Turkish Adult Population

“…1 The lowest normal level is considered to be between L2 and L3 intervertebral disk. 4 The aims of present investigation were to determine the level of termination of the CM by reviewing a large series of magnetic resonance (MR) images in Turkish population and correlate this position with sex, height, and weight. 4 The aims of present investigation were to determine the level of termination of the CM by reviewing a large series of magnetic resonance (MR) images in Turkish population and correlate this position with sex, height, and weight.…”

Reduction of vertebral height with fragility vertebral fractures can induce variety of neurological deterioration

“…Some reports were described that TLCM was more caudally located in females [1, 8, 9] and the elderly [1] and showed differences between races [10–12]. In addition, previous reports revealed that the presence of spinal deformities and lumbosacral transitional vertebrae were associated with variations in the TLCM [13–16].…”