Vertebral level of Tuffier’s line measured by ultrasonography in parturients in the lateral decubitus position

다국어 초록 (Multilingual Abstract)

Background: It is known that Tuffier’s line intersects the spine at the L4 spinous process or at the L4-L5 intervertebral space. Full term parturient women undergo various physical changes. Therefore, determining the vertebral level with Tuffier’s line based on palpation inevitably is not very accurate. The aim of this study was to use ultrasound to verify the difference between vertebral levels for the palpated Tuffier's line in parturient and non-parturient women in the lateral decubitus position.
Methods: We consecutively enrolled 40 parturient women at 37-41 weeks of gestation and 40 non-parturient women scheduled for regional anesthesia. In the left lateral position, the location of the vertebra was identified using ultrasonography. We marked every intervertebral space from L5 to L2 vertebra, divided each spinous process into two equal parts, and numbered the spaces sequentially from 1 to 9. We drew a Tuffier’s line by palpating, recorded the vertebral level that this line intersected.
Results: The mean value of an arbitrary number of vertebral level of Tuffier’s line was 6.4 ± 0.9 in the non-pregnant group and this represents L4-lower vertebral level. In the pregnant group, the mean value was 3.0 ± 1.0 which represents L3-lower vertebral level. There was a significant difference between the two groups (P < 0.05).
Conclusions: We compared using an available ultrasound technique the vertebral levels intersected by the palpated Tuffier's line between parturient and non-parturient women and found that the vertebral levels were more cephalad in the parturient women compared to the non-parturient women.

참고문헌 (Reference)

1 정현균, "미추경막외 차단술에서 초음파의 유효성" 대한척추외과학회 20 (20): 178-183, 2013

2 Chakraverty R, "Which spinal levels are identified by palpation of the iliac crests and the posterior superior iliac spines?" 210 : 232-236, 2007

3 Locks Gde F, "Use of the ultrasound to determine the level of lumbar puncture in pregnant women" 60 : 13-19, 2010

4 Carvalho JC, "Ultrasound-facilitated epidurals and spinals in obstetrics" 26 : 145-158, 2008

5 Michael Haejin Pak, "Ultrasonographic Measurement of the Ligamentum Flavum Depth; Is It a Reliable Method to Distinguish True and False Loss of Resistance?" 대한통증학회 25 (25): 99-104, 2012

6 Saifuddin A, "The variation of position of the conus medullaris in an adult population. A magnetic resonance imaging study" 13 : 1452-1456, 1998

7 Margarido CB, "The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia" 58 : 262-266, 2011

8 Tuominen M, "Spread of spinal anaesthesia with plain 0.5% bupivacaine: influence of the vertebral interspace used for injection" 62 : 358-361, 1989

9 김종해, "Predicting the difficulty in performing a neuraxial blockade" 대한마취통증의학회 61 (61): 377-381, 2011

10 American Society of Anesthesiologists Task Force on Obstetric Anesthesia, "Practice guidelines for obstetric anesthesia: an updated report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia" 106 : 843-863, 2007

11 Kim JT, "Influence of age and sex on the position of the conus medullaris and Tuffier's line in adults" 99 : 1359-1363, 2003

12 Whitty R, "Identification of the lumbar interspinous spaces: palpation versus ultrasound" 106 : 538-540, 2008

13 Ellis H, "Anatomy for anaesthetists" Blackwell 105-106, 2004

14 Duniec L, "Anatomical landmarks based assessment of intravertebral space level for lumbar puncture is misleading in more than 30%" 45 : 1-6, 2013

15 Broadbent CR, "Ability of anaesthetists to identify a marked lumbar interspace" 55 : 1122-1126, 2000