Reliability of Tuffierʼs Line as an Anatomic Landmark

Snider, Karen T.; Kribs, James W.; Snider, Eric J.; Degenhardt, Brian F.; Bukowski, Allison; Johnson, Jane C.

doi:10.1097/brs.0b013e318166f58c

Cited by 48 publications

(32 citation statements)

References 17 publications

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“…[3][4][5] Due to differences related to gender, height, and body mass index (BMI), Tuffier's line has been reported to intersect the vertebral column anywhere from the L3-L4 to the L5-S1 intervertebral discs. [3][4][5][6] In men, Tuffier's line most often intersects the body of L4 or its inferior endplate, whereas in women, it most commonly intersects the body of L5 or its superior endplate. 5 It is imperative to highlight that Tuffier's line is a radiological landmark that does not take into account the patient's body habitus or positioning.…”

Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

“…[3][4][5][6] In men, Tuffier's line most often intersects the body of L4 or its inferior endplate, whereas in women, it most commonly intersects the body of L5 or its superior endplate. 5 It is imperative to highlight that Tuffier's line is a radiological landmark that does not take into account the patient's body habitus or positioning.Ultrasound imaging has become an increasingly popular procedure among anesthesiologists to facilitate neuraxial anesthesia. [7][8][9][10][11][12][13] The use of bedside spinal ultrasound scanning can overcome most of the above-mentioned difficulties in identifying the vertebral interspace accurately, and it has proven to be a valuable clinical tool to improve the accuracy of spine assessment.…”

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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

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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...

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Section: Résumémentioning

confidence: 99%

Section: Résumémentioning

confidence: 99%

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confidence: 99%

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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

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“…showed that Tuffier's line demonstrates predictable sex-related anatomic differences with men having an intercristal line that most often intersects the body of L4 or its inferior endplate and with women having the intercristal line most often intersect the body of L5 or its superior superior endplate [7]. And also showed that weight and BMI are not associated with the level of Tuffier's line in this study.…”

Section: Discussionmentioning

confidence: 52%

“…Tuffier's line is a clinical landmark defined as a horizontal line connecting the superior aspect of the posterior iliac crests and commonly used as a reference to localize the L4 vertebral body before performing a lumbar puncture [7]. However Tuffier's line is unreliable in determining the correct lumbar vertebral level.…”

Section: Discussionmentioning

confidence: 99%

Radiological Evaluation of the Tuffier’s Line in Pediatric Patients

Sargın¹,

Uluer²,

Tutar³

et al. 2016

Ann Clin Anal Med

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ÖzetAmaç: Tuffier çizgisi her iki iliak kristanın en yüksek noktalarının birleştiği hat olarak tanımlanmakta olup genellikle L4 vertebra gövdesinden yada L4-5 vertebral aralıktan geçmektedir. Bu çalışmada Tuffier çizgisinin pediatrik popülasyonda yaş ve cinsiyetle değişimi radyolojik olarak değerlendirilmiştir. Gereç ve Yöntem: Bu çalışmada 16 yaş ve daha küçük 519 hastanın ayakta antero-posterior lomber radyografileri retrospektif olarak değerlendirilmiştir. Değerlendirme şu sıradaki gibi yapıldı: L4 vertebra gövdesi , L4 inferior endplate, L4-L5 disk aralığı, L5 superior endplate, L5 vertebra gövdesi, L5 inferior endplate, L5-S1 disk aralığı.Hastaların cinsiyet, yaş ve Tuffier çizgile-rinin vertebral seviyeleri kaydedildi. Veriler ki-kare testi ile analiz edilmiştir. Bulgular: 315 erkek ve 204 kadın hasta vardı.Tuffier hattı düzeyinde kadın ve erkekler arasında anlamlı bir fark yoktu (p=0.102). Hem erkek hem de kadın gruplarında Tuffier hattı L5 vertebra gövdesinden geçme eğilimindeydi, sıra-sıyla% 44.8 ve% 46.1. Tuffier hattı düzeyinde yaş grupları arasında anlamlı bir fark yoktu (p<0.001). Tuffier çizgisi yaşla birlikte anlamlı olarak yükselme eğilimindeydi. Tartışma: Erkeklerle kıyaslandığında Tuffier çizgisinin kızlarda benzer olduğu ve genç yaş gruplarında önemli ölçüde daha düşük bir konumda olduğu bu çalışmada gösterilmiştir. Tuffier çizgisi pediatrik hastalarda artan yaş ile birlikte anlamlı olarak yükselme göstermektedir. Anahtar KelimelerTuffier Çizgisi; Kristalar Arası Hat; Pediatrik; Yaş; Cinsiyet Abstract Aim: Tuffier's Line (Intercristal line) is defined as the line connecting the highest points of both iliac crests which generally passes through either the body of the L4 vertebra or the intervertebral space between L4-5 vertebrae. In this study, we assessed the radiological evaluation of the level of Tuffier's line with changes in age and gender in pediatric population. Material and Method: In this study, standing anteroposterior lumbar radiographs of 519 patients aged 16 and younger were analyzed retrospectively. Notation was made as to the intersection of this line with one of the following structures: L4 vertebral body, L4 inferior endplate, L4-L5 disc space, L5 superior endplate, L5 vertebral body, L5 inferior endplate, L5-S1 disc space. Patients' gender, age and vertebral level of the Tuffier's line are recorded. Data is analyzed with chi-square test. Results: There were 315 male and 204 female patients.There were no significant difference between females and males on the level of Tuffier's line (p=0.102). In both male and female groups Tuffier's line tended to pass through the L5 vertebral body, respectively 44.8 % and 46.1 %. There was a significant difference between age groups on the level of Tuffier's line (p<0.001). Tuffier's line were significantly increased with ascending ages. Discussion: This study clearly demonstrated that the Tuffier's line were in a similar position in females compared to males and also Tuffier's line were in a significantly lower position in younger age groups...

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The student's dilemma, liver edition: Incorporating the sonographer's language into clinical anatomy education

Hall

Mirjalili

Moore

et al. 2015

Anatomical Sciences Ed

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Anatomy students are often confused by multiple names ascribed to the same structure by different clinical disciplines. Increasingly, sonography is being incorporated into clinical anatomical education, but ultrasound textbooks often use names unfamiliar to the anatomist. Confusion is worsened when ultrasound names ascribed to the same structure actually refer to different structures. Consider the sonographic main lobar fissure (MLF). The sonographic MLF is a hyper-echoic landmark used by sonographers of the right upper quadrant. Found in approximately 70% of people, there is little consensus on what the sonographic MLF is anatomically. This structure appears to be related to the main portal fissure (aka principal plane of the liver or principal hepatic fissure), initially described by anatomists and surgeons as in intrahepatic division along the middle hepatic vein which in essence divides the territories of the left and right hepatic arteries and biliary systems. By exploring the relationship between the main portal fissure and the sonographic MLF in cadaveric livers ex vivo, the data suggest the sonographic MLF is actually an extrahepatic structure that parallels the rim of the main portal fissure. The authors recommend that this structure be renamed the "sonographic cystic pedicle," which includes the cystic duct and ensheathing fat and blood vessels. In the context of the redefined underlying anatomy, the absence of the sonographic cystic pedicle due to anatomic variation may serve an important clinical role in predicting complications from difficult laparoscopic cholecystectomies and is deserving of future study.

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Reliability of Tuffierʼs Line as an Anatomic Landmark

Cited by 48 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 Tuffier’s Line in Pediatric Patients

The student's dilemma, liver edition: Incorporating the sonographer's language into clinical anatomy education

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