Title: Identification of Spinal Level Corresponding to Highest Point of Iliac Crest in Patients Undergoing Lower Lumbar Spinal Surgery- A Clinical, Radiological & Preoperative Observation
Authors: Dr Md. Sumon Rana, Dr Asifur Rahman, Dr Abu Saleh Mohammad Abu Obaida, Dr Robert Ahmed Khan, Dr Md. Motasimul Hasan Shiplu, Dr Ahsan Hafiz, Mohammad Shahnawaz Bari, Muhammad Robiul Hoque, Dr Md.Shafiqul Islam, Mohammad Afzal Hossain
DOI: https://dx.doi.org/10.18535/jmscr/v9i9.01
Abstract
Background: The accurate identification of spinal level is a prerequisite for success and safety of spinal surgery. It may be done clinically by using anatomical landmarks or by using imaging techniques. Anatomical landmarks, including the scapula, ribs, highest point of iliac crest, and posterior superior iliac spine, have been used to assist in identifying specific vertebral levels in the spine. Race, sex, body mass index, height, posture greatly influence this relation. We usually use preoperative L/S spine X-ray to assess the spinal level corresponding to highest point of iliac crest. But after positioning for lower lumbar spinal surgery this spinal level usually changes. It is quite rational to assess the intercristal line with its corresponding spinal level radiologically and peroperatively.
Objective: The aim of the study is to evaluate the changes in spinal level during surgery in comparison to preoperative radiological level.
Method: The cross-sectional study was carried out at the department of neurosurgery in Bangabandhu Sheikh Mujib Medical University from June 2013 till December 2014 among 45 patients. Study Population was including patients over 18 years of age undergoing lumbar region surgery.
Results: In our study, there were 31 (68.8%) males and 14 (31.2%) females. 26 (57.7%) patients had the age below 40 years and 19 (42.3%) patients had age above 40 years. Maximum patients (27%) were male and day labourer, having the diease in our study. Maximum patients (22) had spinal canal stenosis and only few patients (5) had PLID. Preoperative neurological problemslike- sciatalgia, reflex changes, claudication, motor deficit, loss of sensation, sphincter dysfunction were found among patients which postoperatively recovered.
Conclusion: Selection of a high lumbar spinal level basically influence poor identification of the correct spinal level. The intercrestal line is connected with sex, height, weight, or BMI, although weight and BMI were found to have no correlation with the spinal level in this study. This research aided in lumbar spinal surgery by finding the spinal level that corresponds to the highest point of the iliac crest.
Keywords: Spinal level, Spinal surgery, Radiological level.
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