Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines?

Chakraverty, R; Pynsent, Paul; Isaacs, Karen

doi:10.1111/j.1469-7580.2006.00686.x

Cited by 117 publications

(91 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In that study, the interspaces were identified by palpation from C7 to the sacrum. Our alternate hypothesis was based on the study by Chakraverty et al, 15 in which they determined, by means of fluoroscopy, that the palpated intercristal line in the female subgroup was above L4-L5 in 85.7% of cases. Assuming a two-sided type I error of 5% and a type II error of 10%, a sample size of 40 subjects with 90% power was needed to demonstrate that the intercristal line intersects the lumbar spine in term pregnant women in a more cephalad segment than the L4-L5 interspace.…”

Section: Discussionmentioning

confidence: 99%

The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia

Margarido

Mikhael

Arzola

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

Purpose The radiological intercristal line (Tuffier's line) usually intersects the spine at the L4-L5 interspace. The intercristal line determined by palpation may be used erroneously as a surrogate for the true radiological Tuffier's line. We studied term pregnant women to establish the level at which a transverse line connecting the superior aspects of the iliac crests, as determined by palpation, intersects the lumbar spine, as assessed by ultrasound. Methods Term pregnant women were recruited, with the exception of those with scoliosis or previous spinal surgery. With the subjects in the sitting position, the attending anesthesiologist palpated and marked the superior aspects of the iliac crests bilaterally. One of the investigators, blinded to the markings, performed a lumbar spine ultrasound scan to identify the lumbar interspaces. Each interspace was marked on the patient's back. The bilateral markings were then revealed, and a line connecting them was drawn on the patient's back. This line and the markings of the interspace levels were plotted on a transparent sheet. Results Forty-five women were studied. The palpated intercristal line was located above the L4-L5 interspace in all of the women. The median level of intersection was immediately below the L2-L3 interspace, with a range from immediately above L1-L2 to immediately above L4-L5.There was a low positive correlation between the level of intersection and the body mass index (r = 0.32; P = 0.03). Conclusions In pregnant women at term, the intercristal line determined by palpation does not correspond to the Tuffier's line determined radiologically, and it may intersect the spine at up to three interspaces higher. RésuméObjectif La ligne de Tuffier radiologique croise en ge´ne´ral la colonne verte´brale a`l'espace entre L4 et L5. La ligne de Tuffier telle que de´termine´e par palpation pourrait eˆtre utilise´e à tort comme substitut de la ve´ritable ligne de Tuffier radiologique. Nous avons e´tudie´des parturientes at erme afin d'e´tablir le niveau auquel une ligne transverse connectant les aspects supe´rieurs des creˆtes iliaques, telle que de´termine´e par palpation, croise la colonne lombaire, telle qu'e´value´e par e´chographie. Méthode Des parturientes a`terme ont e´te´recrute´es, al 'exception des patientes souffrant de scoliose ou ayant subi une chirurgie rachidienne par le passe´. En plaçant les patientes dans une position assise, l'anesthe´siologiste a palpe´et marque´les aspects supe´rieurs des creˆtes iliaques de façon bilate´rale. L'un des chercheurs, ne voyant pas les marques, a re´alise´une e´chographie de la colonne lombaire afin d'identifier les espaces interlombaires. Chaque espace a e´te´marque´sur la peau du dos des patientes. Les marques bilate´rales ont ensuite e´te´re´ve´le´es, et une ligne les connectant a e´te´dessine´e. Cette ligne et les marques des espaces interlombaires ont e´te´reproduites sur une feuille transparente. Résultats Quarante-cinq femmes ont e´te´e´tudie´es. La ligne de Tuffier telle que de´termine´e p...

show abstract

Section: Discussionmentioning

confidence: 99%

The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia

Margarido

Mikhael

Arzola

et al. 2010

Can J Anesth/J Can Anesth

View full text Add to dashboard Cite

show abstract

“…T uffier çizgisi, her iki iliak kristanın en yüksek noktalarını birleştiren, genellikle 4. lomber (L4) vertebranın gövdesi veya 4. lomber ve 5. lomber vertebralar arasından (L4-L5) geçen çizgidir (1). Rutin klinik uygulamada nöroaksiyal blok uygulanacak hastalarda Tuffier çizgisinin geçtiği intervertebral aralık belirlenerek, işlem bu seviyeden yapılır.…”

Section: Introductionunclassified

Radiological Evaluation of the Line Between the Crista Iliaca (Tuffier’s line) in Elderly Patients

Horsanalı¹,

Tekgül²,

Özkalkanlı³

et al. 2015

Turk J Anesth Reanim

View full text Add to dashboard Cite

Objective: Tuffier's line is defined as the line connecting the highest points of both iliac crests, which generally passes through either the body of the fourth lumbar vertebra or the intervertebral space between fourth and fifth vertebrae. In this study, we assessed the radiological correlation of the level of Tuffier's line with changes in age and sex. Methods:In this study, antero-posterior pelvic X-rays of 590 patients aged 18 and older were retrospectively analyzed. It is revealed that Tuffier's line crosses the vertebral column at one of three levels, which are the L4 vertebral body, L4-L5 vertebral interspace and L5 vertebral body. Patients' sex, age and vertebral level of the Tuffier's line were recorded. Data was analyzed using the chi-square test. Results:The assessment of the X-rays of 317 female patients showed that Tuffier's Line passes through the L4 vertebral body in 115 (37.8%), through the L4-L5 intervertebral space in 126 (40%) and through the L5 vertebral body in 76 (22.2%) patients. A Tuffier's line passing through the level of the L5 vertebral body was found to be statistically significant in female patients (p=0.00). No significant relevance was found between male gender and the level of Tuffier's line in 273 male patients. It is found that the height of the vertebral levels that Tuffier's line crosses does not correlate with mean age of the groups (p=0.939). Conclusion:It should be considered that Tuffier's line can cross at vertebral levels other than anticipated. The level of Tuffier's line should be precisely determined with supplementary radiological methods, such as AP pelvic X-ray in addition to physical examination, to reduce the complications in association with regional anesthesia and to achieve sensorial block levels sufficient to sustain a comfortable surgery, particularly in female patients who carry higher cardiac and respiratory risks.Keywords: Tuffier's line, crista iliac, age, sex Amaç: Tuffier çizgisi, her iki iliak kristanın en yüksek noktalarını birleştiren, genellikle 4. lomber vertebranın gövdesi veya 4 ve 5. lomber vertebralar arasından geçen çizgidir. Bu çalışmada yaş ve cinsiyetteki değişimlerle Tuffier çizgisinin seviyesi arasındaki korelasyon radyolojik olarak değerlendirilmiştir.Yöntemler: Çalışmada antero-posterior pelvis grafisi kayıtları olan 18 yaş ve üstü 590 hasta retrospektif olarak incelendi. Grafilerde Tuffier çizgisinin vertebra kolonuyla kesiştiği noktalar L4 vertebra korpusu, L4-5 intervertebral aralık, L5 vertebra korpusu olarak belirlendi. Hastaların cinsiyetleri, yaşları ve Tuffier çizgisinin geç-tiği vertebra seviyeleri kaydedildi. Veriler ki-kare testi ile değer-lendirildi.Bulgular: Çalışmada 317 kadın hastanın 115'inde (%37,8) Tuffier çizgisinin L4 vertebra korpusu, 126'sında (%40) L4-5 intervertebral aralık, 76'sında (%22,2) L5 vertebra korpusu seviyesinden geçtiği görüldü. Tuffier çizgisinin L5 vertebra korpusu seviyesinden geçmesinin kadın hasta grubunda istatistiksel olarak anlamlı olduğu saptandı (p=0,00). 273 Erkek hastada cinsiyet ile Tu...

show abstract

“…The intercristal line is defined as the line joining the superior aspect of the iliac crests posteriorly (2). Chakraverty et al suggests that clinical palpation of the intercristal line commonly identifies the L3 or L3-4 spinal levels rather than the L4 or L4-5 levels, particularly in females and patients with higher body mass indices (3). On the other hand, the intercristal line is commonly identified as the L4-5 spinal level on radiographs.…”

Section: Introductionmentioning

confidence: 99%

“…The intercristal line was determined and based on it, the pathology related spinous process or interspinous space corresponding to the spinal pathology was estimated and marked using a surgical ink marker. The intercristal line was taken to be the L4-5 spinal level in a young thin male and L3-4 spinal level in all other patients (3). Palpable deformities such as widening of the interspinous space in patients with traumatic flexion distraction injuries and focal kyphosis as seen on pre-operative imaging were adjuncts used to further refine this process.…”

Section: Pathology Related Spine Level Localizationmentioning

confidence: 99%

Factors predictive of topographical accuracy in spine level localization

et al. 2017

View full text Add to dashboard Cite

Background: Pre-operative spine level localization by palpation of anatomical landmarks (ribs, spinous processes) in posterior approaches for surgeries from T4 to L2 is often inaccurate. This can lead to ineffective utilization of procedural time, increased radiation dose, potentially longer skin incision and wrong level surgery. Factors affecting topographical accuracy includes body mass index (BMI) of the patient, congenital or acquired deformity and knowledge of topographical anatomy.Methods: All patients had the presumed location of their pathology marked on the skin using anatomical landmarks prior to application of the Target Tape ® (Vancouver, BC, Canada) and verification using an anterior-posterior radiograph. Potential factors predictive of accurate pre-operative spine level localization such as age, gender, BMI, palpable deformity, pathology related interspinous distance (ISPD) and pathology related skin to spinous process distance were evaluated.Results: A prospective study was performed with 30 consecutive patients undergoing posterior spine surgery (T4 to L2). Accuracy of pathology related spine level localization using anatomical landmarks was only 40%. Pathology related ISPDs of more than 10 mm and palpable deformity was significantly correlated with successful determination of spine levels using anatomical landmarks.Conclusions: This study showed that poor spine level localization using anatomical landmarks was associated with pathology related ISPDs of less than 10 mm. Conversely, patients with palpable spinal deformity have their levels easily localized.

show abstract

Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines?

Cited by 117 publications

References 17 publications

The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia

The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia

Radiological Evaluation of the Line Between the Crista Iliaca (Tuffier’s line) in Elderly Patients

Factors predictive of topographical accuracy in spine level localization

Contact Info

Product

Resources

About