Ramapati Sanyal

Abstract

Introduction: The assessment of spinal levels by palpation using the superior aspect of iliac crest as a guide is a routine practice. Through this study we want to assess the accuracy of the determination of lumbar spinal spaces by palpation of iliac crest and posterior superior iliac spine using an X- ray image intensifier. Materials and Methods: 132 Patients scheduled for lower limb orthopaedic surgery were included. The spinal level corresponding to the intercristal line (ICL) and posterior superior iliac spine (PSIS) line was identified by palpation and marked with a radio-opaque marker in the sitting position. A radiology image was then taken in supine position to locate the position of the markers. Results: The levels identified by palpation were in agreement with radiological levels in 51.5% of cases. In 39% cases the level identified was one space higher and in 9.5% cases it was two spaces higher. PSIS line identified the L5-S1 inter-spinous space in 34 (25.75%) patients, S1 and S2 spinous processes in 52 (39%) patients and 17 (12.8%) patients respectively. Conclusion: In 49% of the cases there was an inaccurate identification of the spinal level by palpation of iliac crest in cephalad direction, more so in elderly patients and patients with higher BMIs. So in these cases a clinician should be doubtful of the palpated landmark to be corresponding to a higher level. PSIS line ranges from L4-L5 interspace to S2 spinous process and therefore cannot be a reliable guide for identification of a spinal level. Keywords: Interspinous space, Palpation, Radiology, Intercristal line, Posterior superior iliac spine.

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