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Vertebral level identified by the intercristal line: Confirmation by ultrasound

  • Drew Brotherston
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada

    Division of General Internal Medicine, Department of Medicine, University of Toronto, Canada
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  • Janeve Desy
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada
    Search for articles by this author
  • Irene W.Y. Ma
    Correspondence
    Corresponding author at: Division of General Internal Medicine, Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada.
    Affiliations
    Division of General Internal Medicine, Department of Medicine, University of Calgary Cumming School of Medicine, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada

    W21C, University of Calgary, Canada

    Department of Community Health Sciences, University of Calgary, Canada

    Division of Emergency Ultrasound, Department of Emergency Medicine, Massachusetts General Hospital, United States
    Search for articles by this author
Published:January 22, 2021DOI:https://doi.org/10.1016/j.ejim.2021.01.015
      Prior to performing a lumbar puncture (LP) at the bedside, the intercristal line, formed posteriorly between the superior aspect of the iliac crests, commonly serves as a landmark to identify the L4 spinous process or L4–L5 intervertebral disc. However, the vertebral level actually identified by this line may be highly variable, ranging from L1–L2 to L5–S1 [
      • Margarido C.B.
      • Mikhael R.
      • Arzola C.
      • Balki M.
      • Carvalho J.C.
      The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia.
      ,
      • Cooperstein R.
      • Truong F.
      Systematic review and meta-analyses of the difference between the spinal level of the palpated and imaged iliac crests.
      ]. Given that the conus medullaris may terminate as low as the superior third of the L3 vertebral body in some patients [
      • Demiryurek D.
      • Aydingoz U.
      • Aksit M.D.
      • Yener N.
      • Geyik PO
      MR imaging determination of the normal level of conus medullaris.
      ,
      • Macdonald A.
      • Chatrath P.
      • Spector T.
      • Ellis H.
      Level of termination of the spinal cord and the dural sac: a magnetic resonance study.
      ,
      • Saifuddin A.
      • Burnett S.J.
      • White J.
      The variation of position of the conus medullaris in an adult population. A magnetic resonance imaging study.
      ], using the intercristal line alone prior to neuraxial procedures may place some patients at risk of cord injury.

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