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Korean J Anesthesiol > Volume 35(4); 1998 > Article
Korean Journal of Anesthesiology 1998;35(4):691-695.
DOI: https://doi.org/10.4097/kjae.1998.35.4.691   
The Level of Tuffier's Line of Korean Adults in the Lateral Decubitus Position with the Position of "Forehead-to-knees".
Il Ok Lee, Jae Hwan Kim, Young Cheol Park, Jung Yul Park, Sang Hoon Cha
1Department of Anesthesiology, Korea University College of Medicine, Seoul, Korea.
2Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea.
3Department of Radiology, Korea University College of Medicine, Seoul, Korea.
Abstract
BACKGREOUND: Tuffier's line has been a guide for lumbar puncture. Usually lumbar puncture or epidural anesthesia was performed in the lateral decubitus position with the "forehead-to-knees" position. The purpose of this study was to identify the accuracy with which the spinal level could be predicted from this external mark in the "forehead-to-knees" position.
METHODS
Two hundred and twenty-four patients (112 male and 112 female patients) undergoing investigation for back pain were examined. The standard antero-posterior lumbar spine film was taken in the supine position. The lateral lumbar spine film was taken in the lateral decubitus with the "forehead-to-knees" position. These films were examined after being reported upon by a radiologist. The iliac crest was identified and a horizontal line drawn between the highest points using a ruler. The level of Tuffier's line of each age group in supine or "forehead-to-knees" position and relationship with aging were observed.
RESULTS
The point coincided with the L4-5 interspace (61%), L4 (20%), and L5 (19%) in the supine, L4-5 (48%), L5 (46%), L4 (5%), and L5S1 (0.4%) in the "forehead-to-knees" position. The Tuffier's line of men were higher than women. The Tuffier's line in the "forehead-to-knees" position went higher with aging in women.
CONCLUSIONS
The Tuffier's line was most frequently the L4-5 interspace in supine and "forehead-to-knees" positions. The Tuffier's line in the "forehead-to-knees" was lower than the supine position. The Tuffier's line of men were higher than women of all age groups in the supine position. The Tuffier's line in the "forehead-to-knees" position went higher with aging in women. The Tuffier's line in the supine position in women and of both positions in men did not show any relation with age.


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