The value of Tuffier's line for neonatal neuraxial procedures

The spine of L4 usually lies on a line drawn between the highest points of the iliac crests (Tuffier's line) in adults. Although its accuracy has been questioned, it is still commonly used to identify the spinous process of the 4th lumbar vertebra before performing lumbar neuraxial procedures....

Full description

Saved in:
Bibliographic Details
Published in:Clinical anatomy (New York, N.Y.) N.Y.), 2014-04, Vol.27 (3), p.370-375
Main Authors: van Schoor, Albert, Bosman, M.C., Bosenberg, A.T.
Format: Article
Language:English
Subjects:
Anatomic Landmarks
Anesthesia, Epidural - methods
Anesthesia, Spinal - methods
Cadaver
child
Humans
Ilium - anatomy & histology
Infant, Newborn
inter-cristal line
lumbar epidural
lumbar puncture
lumbar spinous process
Lumbar Vertebrae - anatomy & histology
Patient Positioning - methods
pediatric
Prone Position
Sacrococcygeal Region - anatomy & histology
spinal anesthesia
Spinal Cord - anatomy & histology
Spinal Puncture - methods
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The spine of L4 usually lies on a line drawn between the highest points of the iliac crests (Tuffier's line) in adults. Although its accuracy has been questioned, it is still commonly used to identify the spinous process of the 4th lumbar vertebra before performing lumbar neuraxial procedures. In children, this line is said to cross the midline at the level of L5. A literature search revealed that the description this surface anatomical line is vague in neonates. The aims of this study were to determine the vertebral level of Tuffier's line, as well as its distance from the apex of the sacrococcygeal membrane (ASM), in 39 neonatal cadavers in both a prone and flexed position. It was found that when flexed, Tuffier's line shifted from the level of L4/L5 (prone position) to the upper third of L5. The mean distance from the ASM to Tuffier's line was 23.64mm when prone and 25.47 mm when flexed, constituting a statistically significant increase in the distance (P=0.0061). Therefore, in the absence of advanced imaging modalities, Tuffier's line provides practitioners with a simple method of determining a level caudal to the termination of the spinal cord, at approximately the L4/L5 in a prone neonate and the upper margins of L5 when flexed. Clin. Anat. 27:370–375, 2014. © 2013 Wiley Periodicals, Inc.
ISSN:0897-3806
1098-2353
DOI:10.1002/ca.22218