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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
- 作者:Nan Lin (5)
Yan Li (5) John F Bebawy (6) Jia Dong (5) Lin Hua (7)
5. Department of Anesthesiology ; Beijing Tiantan Hospital ; Capital Medical University ; Beijing ; 100050 ; P.R. China 6. Northwestern University Feinberg School of Medicine ; 251 E. Huron St. ; Suite F5-704 ; Chicago ; IL ; 60611 ; USA 7. Biomedical Engineering Institute of Capital Medical University ; Beijing ; 100069 ; China
- 关键词:Lumbar interspace ; Spinal anesthesia ; Cobb’s angle ; Abdominal circumference
- 刊名:BMC Anesthesiology
- 出版年:2015
- 出版时间:December 2015
- 年:2015
- 卷:15
- 期:1
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2. Hamandi K, Mottershead J, Lewis T, Ormerod IC, Ferguson IT: Irreversible damage to the spinal cord following spinal anesthesia. / Neurology 2002,59(4):624-. 10.1212/WNL.59.4.624 59.4.624" target="_blank" title="It opens in new window">CrossRef 3. Broadbent CR, Maxwell WB, Ferrie R, Wilson DJ, Gawne-Cain M, Russell R: Ability of anaesthetists to identify a marked lumbar interspace. / Anaesthesia 2000,55(11):1122-. 10.1046/j.1365-2044.2000.01547-4.x 5-2044.2000.01547-4.x" target="_blank" title="It opens in new window">CrossRef 4. Snider KT, Snider EJ, Degenhardt BF, Johnson JC, Kribs JW: Palpatory accuracy of lumbar spinous processes using multiple bony landmarks. / J Manipulative Physiol Ther 2011,34(5):306-3. 10.1016/j.jmpt.2011.04.006 CrossRef 5. Tanaka K, Irikoma S, Kokubo S: Identification of the lumbar interspinous spaces by palpation and verified by X-rays. / Rev Bras Anestesiol 2013,63(3):245-. 10.1016/S0034-7094(13)70224-1 CrossRef 6. Navarro R, Guasch E, Parodi E, Gilsanz F: Assessment of agreement between anesthesiologists' location of anatomical landmarks. / Rev Esp Anestesiol Reanim 2008,55(3):144-0. 10.1016/S0034-9356(08)70532-2 56(08)70532-2" target="_blank" title="It opens in new window">CrossRef 7. Windisch G, Ulz H, Feigl G: Reliability of Tuffier's line evaluated on cadaver specimens. / Surg Radiol Anat 2009,31(8):627-0. 10.1007/s00276-009-0493-z CrossRef 8. Teoh DA, Santosham KL, Lydell CC, Smith DF, Beriault MT: Surface anatomy as a guide to vertebral level for thoracic epidural placement. / Anesth Analg 2009,108(5):1705-. 10.1213/ane.0b013e31819cd8a3 CrossRef 9. Cobb JR: Outline for the study of scoliosis. / In Instructional Course Lectures, The American Academy of Orthopaedic Surgeons 1948, 5:261-5. 10. Tayyab NA, Samartzis D, Altiok H, Shuff CE, Lubicky JP, Herman J, / et al.: The reliability and diagnostic value of radiographic criteria in sagittal spine deformities: comparison of the vertebral wedge ratio to the segmental cobb angle. / Spine (Phila Pa 1976) 2007,32(16):E451-. 10.1097/BRS.0b013e3180ca7d2d CrossRef 11. Pysyk CL, Persaud D, Bryson GL, Lui A: Ultrasound assessment of the vertebral level of the palpated intercristal (Tuffier's) line. / Can J Anaesth 2009,57(1):46-. 5" target="_blank" title="It opens in new window">CrossRef 12. Ye Y, Bao Y, Hou X, Pan X, Wu H, Li H, / et al.: Identification of waist circumference cutoffs for abdominal obesity in the Chinese population: a 7.8-year follow-up study in the Shanghai urban area. / Int J Obes (Lond) 2009,Anesthesiology; Internal Medicine; Emergency Medicine; Intensive / Critical Care Medicine; - 出版者:BioMed Central
- ISSN:1471-2253
文摘
Background Lumbar 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. Methods 52 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. Results Patients 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. Conclusions Patients-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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