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 [
[1]
,
[2]
]. Given that the conus medullaris may terminate as low as the superior third of the
L3 vertebral body in some patients [
3
,
4
,
5
], using the intercristal line alone prior to neuraxial procedures may place some patients
at risk of cord injury.Keywords
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References
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- Effect of spinal flexion on the conus medullaris: a case series using magnetic resonance imaging.Anaesthesia. 2006; 61: 521-523
- Diagnostic lumbar puncture.Uster Med. 2014; 85: 93-102
- Damage to the conus medullaris following spinal anaesthesia.Anaesthesia. 2001; 56: 238-247
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Article info
Publication history
Published online: January 22, 2021
Accepted:
January 15,
2021
Received in revised form:
January 11,
2021
Received:
December 16,
2020
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
