Spinal landmark depth in relation to body mass index

Kawchuk, Gregory N.; Prasad, Narasimha; Parent, Éric; Chapman, Sheena; Custodio, Marianne; Manzon, Maria M.; Wiebe, Amanda; Dhillon, Suki

doi:10.1016/j.math.2011.01.007

Cited by 16 publications

(16 citation statements)

References 8 publications

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“…First, different application sites have different amounts of soft tissue between the skin and the vertebra [26]. This creates the possibility that SMT forces are attenuated differently at different application sites.…”

Section: Discussionmentioning

confidence: 99%

The effect of application site of spinal manipulative therapy (SMT) on spinal stiffness

Edgecombe¹,

Kawchuk²,

Long³

et al. 2015

The Spine Journal

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Section: Discussionmentioning

confidence: 99%

The effect of application site of spinal manipulative therapy (SMT) on spinal stiffness

Edgecombe¹,

Kawchuk²,

Long³

et al. 2015

The Spine Journal

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“…Various patient factors resulted in the inaccuracy in identifying the correct lumbar interspace which we observed. Obviously, landmark depth increases with increasing subject BMI, which theoretically would influence palpation performance [ 13 ]. Although weight and BMI do not affect the radiographic Tuffier’s line [ 14 ], it would seem that palpated bony anatomy projections are affected by fat and muscle distribution.…”

Section: Discussionmentioning

confidence: 99%

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

Bebawy

et al. 2015

BMC Anesthesiol

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BackgroundLumbar puncture for spinal or epidural anesthesia is commonly performed by palpating bony landmarks, but identification of the desired intervertebral level is often inaccurate. It is unclear whether such inaccuracy is related to patient factors, such as body mass index and degree of lumbar flexion. We hypothesized that overweight patients and patients with less of an ability to hyperflex their lumbar spines are prone to inaccurate lumbar spinous intervertebral level identification.Methods52 adult volunteers were included in this study. 7 anesthesiologists with different years of experience identified and marked subjects’ levels of the iliac crests, then marked the presumed interspaces. Lumbar X-ray was then performed with metal markers, and actual radiographic findings were identified and compared to the initial markings.ResultsPatients with larger abdominal circumferences (mean (SD), 94.0(12.1) cm), higher body mass indices (25.9(3.9) kg/m2), and aged between 50 and 70 years old had lumbar interspaces that were higher than the presumed level; patients with smaller abdominal circumferences (82.8(13.5) cm) and lower body mass indices (21.6(4.1) kg/m2) had intervertebral levels that were lower than the presumed level. Cobb’s angle, indicating the degree of lumbar flexion, did not affect the accuracy obtained.ConclusionsPatients’ abdominal circumference, body mass index, and age are factors that may impact the accuracy of lumbar level identification. Tuffier’s line, as identified by palpation, does not seem to be a reliable landmark for proper lumbar interspace identification in all cases.

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“…However, transforaminal epidural injections are also associated with substantial risk compared to either caudal or interlaminar epidural injections (2,(8)(9)(10)(11)(12)(13)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Further, multiple prognostic indicators (30)(31)(32)(33), the depth of the epidural space (34,35), the relationship of the radicular medullary artery (36), injectate volumes required (37)(38)(39)(40), filling patterns (14,15), and multiple modifications to improve safety and effectiveness (41)(42)(43)(44)(45)(46)(47)(48) are important in treating multiple types of painful conditions (1,7,11,49,50). Transforaminal epidural injections have been utilized for multiple indications including lumbar radiculitis with or without disc herniation, discogenic pain, spinal stenosis, and in post lumbar surgery syndrome…”

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confidence: 99%

Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

Manchikanti

2012

Pain Phys

154

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Background: Among the multiple interventions used in managing chronic spinal pain, lumbar epidural injections have been used extensively to treat lumbar radicular pain. Among caudal, interlaminar, and transforaminal, transforaminal epidural injections have gained rapid and widespread acceptance for the treatment of lumbar and lower extremity pain. The potential advantages of transforaminal over interlaminar and caudal, include targeted delivery of a steroid to the site of pathology, presumably onto an inflamed nerve root. However, there are only a few well-designed, randomized, controlled studies on the effectiveness of steroid injections. Consequently, multiple systematic reviews with diverse opinions have been published. Study Design: A systematic review of therapeutic transforaminal epidural injection therapy for low back and lower extremity pain. Objective: To evaluate the effect of therapeutic transforaminal lumbar epidural steroid injections in managing low back and lower extremity pain. Methods: The available literature on lumbar transforaminal epidural injections in managing chronic low back and lower extremity pain was reviewed. The quality assessment and clinical relevance criteria utilized were the Cochrane Musculoskeletal Review Group criteria as utilized for interventional techniques for randomized trials and by the Newcastle-Ottawa Scale criteria for observational studies. Data sources included relevant literature identified through searches of PubMed and EMBASE from 1966 to December 2011, and manual searches of the bibliographies of known primary and review articles. The level of evidence was classified as good, fair, or poor based on the quality of evidence developed by the U.S. Preventive Services Task Force (USPSTF). Outcome Measures: The primary outcome measure was pain relief (short-term relief = up to 6 months and long-term > 6 months). Secondary outcome measures were improvement in functional status, psychological status, return to work, and reduction in opioid intake. Results: For this systematic review, 70 studies were identified. Of these, 43 studies were excluded and a total of 27 studies met inclusion criteria for methodological quality assessment with 15 randomized trials (with 2 duplicate publications) and 10 non-randomized studies. For lumbar disc herniation, the evidence is good for transforaminal epidural with local anesthetic and steroids, whereas it was fair for local anesthetics alone and the ability of transforaminal epidural injections to prevent surgery. For spinal stenosis, the available evidence is fair for local anesthetic and steroids. The evidence for axial low back pain and post lumbar surgery syndrome is poor, inadequate, limited, or unavailable. Limitations: The limitations of this systematic review include the paucity of literature. Conclusion: In summary, the evidence is good for radiculitis secondary to disc herniation with local anesthetics and steroids and fair with local anesthetic only; it is fair for radiculitis secondary to spinal stenosis with local anesthetic and steroids; and limited for axial pain and post surgery syndrome using local anesthetic with or without steroids. Key words: Spinal pain, chronic low back pain, lower extremity pain, transforaminal epidural steroids, radiculopathy, sciatica, steroids, local anesthetic

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Spinal landmark depth in relation to body mass index

Cited by 16 publications

References 8 publications

The effect of application site of spinal manipulative therapy (SMT) on spinal stiffness

The effect of application site of spinal manipulative therapy (SMT) on spinal stiffness

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

Effectiveness of Therapeutic Lumbar Transforaminal Epidural Steroid Injections in Managing Lumbar Spinal Pain

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