Variation in position of the L4/5 disc inter-space from the anatomical landmark: review of 450 radiographs and clinical applications

Walsh, James; Quinlan, John; Butt, Kimberly; Towers, M; Devitt, Aiden

doi:10.1007/s00590-005-0075-7

Cited by 14 publications

(8 citation statements)

References 9 publications

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“…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).…”

Section: Supracristal Planesupporting

confidence: 83%

“…The supracristal or intercristal plane is frequently used as a guide for lumbar puncture, spinal injection, and for siting incisions in patients undergoing spinal surgery (Walsh et al, 2006). 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).…”

Section: Supracristal Planementioning

confidence: 99%

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

2010

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Accurate surface anatomy is a key component of safe clinical practice. But how consistent are modern clinical and surface anatomy texts in their reporting of common surface anatomy landmarks? Thirteen popular texts in common use were analyzed in detail: one clinical and anatomical reference text; seven clinical anatomy texts; two surface anatomy texts; and three clinical examination texts. Content relating to surface anatomy was reviewed, summarized, and assessed for consistency. Four main findings emerged: (i) there are numerous inconsistencies in clinically important surface markings (e.g., the femoral artery in the groin, superficial and deep inguinal rings, and accessory nerve in the posterior triangle), including inconsistencies within some texts; (ii) there is a consensus on many surface markings, e.g., the spleen and termination of the spinal cord; (iii) few texts address variation in surface anatomy related to age, sex, body mass, posture, respiration, and ethnicity; and (iv) the three standard clinical examination texts included in this review contain comparatively little surface anatomy. Seven surface anatomy landmarks were redefined within an evidence-based framework: termination of the spinal cord, supracristal plane, base of the appendix, renal length, the deep inguinal ring, the femoral artery in the groin, and the accessory nerve in the posterior triangle of the neck. An evidence-based framework is essential if surface anatomy is to be accurate and clinically relevant.

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Section: Supracristal Planesupporting

confidence: 83%

Section: Supracristal Planementioning

confidence: 99%

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

2010

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“…Furthermore, this study reveals that the intercristal line in 70.9% passed through L4/5 disc, whereas, in 29.1%, it passes below L4/5. Previous studies, on the other hand, reveal that it passes through L4/4 in 31.9% and higher in the rest (Walsh et al, 2006). This suggests that the position of this line is not uniform.…”

Section: Discussionmentioning

confidence: 76%

“…These landmarks are useful guides during spinal surgery, lumbar punctures, epidural, and spinal anesthesia (Standring, 2005). Their levels of intersection with the spine vary within and between populations depending on ethnicity (Render, 1996;Walsh et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

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

2010

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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.

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“…The supracristal plane, also defined as the ‘intercristal’ line (Lumey, ) and the ‘transcristal’ plane (Ellis and Mahadevan, ), was described as between the L4 and L4‐5 intervertebral disc levels in previous studies (Walsh et al, ; Chakravetry et al, ; Mirjalili et al, ). It was mostly at the L4 vertebra level in the present study (69%), in accordance with others.…”

Section: Discussionmentioning

confidence: 99%

Surface anatomy and anatomical planes in the adult turkish population

et al. 2015

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Surface anatomy and anatomical planes are widely used in education and clinical practice. The planes are largely derived from cadaveric studies and their projections on the skin show discrepancies between and within anatomical reference textbooks. In this study, we reassessed the accuracy of common thoracic and abdominopelvic anatomical planes using computed tomography (CT) imaging in the live adult Turkish population. After patients with distorting pathologies had been excluded, CT images of 150 supine patients at the end tidal inspiration were analyzed. Sternal angle, transpyloric, subcostal, supracristal and pubic crest planes and their relationships to anatomical structures were established by dual consensus. The tracheal bifurcation, azygos vein/superior vena cava (SVC) junction and pulmonary bifurcation were usually below the sternal angle while the concavity of the aortic arch was generally within the plane. The tip of the tenth rib, the superior mesenteric artery and the portal vein were usually within the transpyloric plane while the renal hila and the fundus of the gallbladder were below it. The inferior mesenteric artery was below the subcostal plane and the aortic bifurcation was below the supracristal plane in most adults. Projectional surface anatomy is fundamental to medical education and clinical practice. Modern cross-sectional imaging techniques allow large groups of live patients to be examined. Classic textbook information regarding anatomy needs to be reviewed and updated using the data gathered from these recent studies, taking ethnic differences into consideration.

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Variation in position of the L4/5 disc inter-space from the anatomical landmark: review of 450 radiographs and clinical applications

Cited by 14 publications

References 9 publications

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

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

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

Surface anatomy and anatomical planes in the adult turkish population

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