English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

The assessment of spinal levels by palpation using the superior aspect of iliac crest as a guide is a routine practice. Through this study we want to assess the accuracy of the determination of lumbar spinal spaces by palpation of iliac crest and posterior superior iliac spine using an Xray image intensifier. Materials and Methods: 132 Patients scheduled for lower limb orthopaedic surgery were included. The spinal level corresponding to the intercristal line (ICL) and posterior superior iliac spine (PSIS) line was identified by palpation and marked with a radio-opaque marker in the sitting position. A radiology image was then taken in supine position to locate the position of the markers. Results: The levels identified by palpation were in agreement with radiological levels in 51.5% of cases. In 39% cases the level identified was one space higher and in 9.5% cases it was two spaces higher. PSIS line identified the L5-S1 inter-spinous space in 34 (25.75%) patients, S1 and S2 spinous processes in 52 (39%) patients and 17 (12.8%) patients respectively. Conclusion: In 49% of the cases there was an inaccurate identification of the spinal level by palpation of iliac crest in cephalad direction, more so in elderly patients and patients with higher BMIs. So in these cases a clinician should be doubtful of the palpated landmark to be corresponding to a higher level. PSIS line ranges from L4-L5 interspace to S2 spinous process and therefore cannot be a reliable guide for identification of a spinal level. Introduction Identification of lumbar space by palpation of superior aspect of iliac crest as a guide is a standard practice. The line connecting the highest points of both iliac crests is known as the Tuffier’s line or intercristal line (ICL); it generally passes through the fourth lumbar vertebra or the inter-vertebral space between fourth and fifth vertebrae. Using this as a reference, spinal anesthesia is given at an inter-vertebral space between third and fourth lumbar vertebrae or fourth and fifth lumbar vertebrae; in order to avoid an injury to the spinal cord which usually ends at the second lumbar vertebra. Lower limb orthopaedic surgeries are usually performed under neuraxial blockade; spinal, epidural or a combined block. The blockade is performed with the patient either in sitting or in lateral position. The proper positioning of patients going for lower limb surgeries is sometimes difficult due to the associated pain. The major concern with improper positioning is incorrect identification of the intervertebral space, as a result of which anesthesia may be given at a level higher to conus medullaris. Transient and permanent neurological damage may occur as a result of direct trauma from the spinal or epidural needle to a low lying spinal cord or in case of an inadvertent high needle insertion. An accuracy varying from 30% to 70% has been demonstrated in previous studies among varied populations including elderly and pregnant patients. The reason for the wide variation in accuracy of lumbar space identification may be because of the variation in the built, height and BMI of the people of different ethnicity. The line joining the two-posterior superior iliac spines (PSIS line) is stated to cross the second sacral vertebrum and has been used as a reference for giving subarachnoid block for Taylor approach and S2 trans-foraminal block. Objectives We conducted this study to assess the accuracy of spinal level identification by palpation of the iliac crest, which we confirmed by fluoroscopy; in patients undergoing lower limb orthopaedic surgeries. We also assessed the effect of age, sex and body mass Index (BMI) on the accuracy of identification of the spinal level by Tuffier’s line and spinal Article Info Received: 9th January, 2019 Accepted: 22nd April, 2019 Published Online: 22nd August, 2019

indian journal of clinical anaesthesia

Correlation between the spinal levels identified by palpation of the iliac crests and the posterior superior iliac spine and radiology in patients undergoing lower limb orthopaedic surgeries