Relationship between Age, Sex and Anthropometric Factors with The Distance of L4-L5 Interspace from Tuffier’s Line among Malay race: Observational Study with Ultrasonography Guidance
Introduction: The anatomical marker used in spinal anesthesia is L4-L5 interspace which thought to be located on the Tuffier’s line as it connects the two highest points on the iliac crest. The location of L4-L5 interspace from the Tuffier’s line varies greatly due to several factors such as differences in race, sex, age, and anthropometric factors.
Objective: To examine the relationship between age, sex and anthropometric factors with the distance of L4-L5 interspace from Tuffier’s line among Malay race patients using ultrasound guidance at Cipto Mangunkusumo hospital.
Material and Methods: This was an observational analytic study with cross sectional design. Following the approval from ethical committee, patients undergoing spinal anesthesia at Cipto Mangunkusumo hospital from February to May 2017 whose informed consent has been obtained were admitted in the study. A total of 93 subjects were included using consecutive sampling. Distance was measured using curve probe ultrasonography by anesthesiology resident under the supervision of anesthesiologist. The intersection point between Tuffier’s line obtained through palpation and line passing through each spinous process obtained through ultrasound was first identified. The midpoint of L4-L5 was identified through ultrasonography then distance between these two points was measured. Statistical analysis was performed to find the relationship between age, sex and anthropometric factors (height, weight, and body mass index) with the distance L4-L5 interspace from Tuffier’s line using Mann Withney and Pearson test. Multivariate analysis with linear regression was used to obtain the prediction formula of the distance between L4-L5 interspace to the Tuffier’s line on the Malay race.
Results and Discussion: This study generated that the distance of L4-L5 interspace from the Tuffier line is -2.59 ± 1.58 cm. Correlation analysis showed a significant relationship between sex to the distance of L4-L5 interspace and the Tuffier’s line. Men were shown to have longer L4-L5 interspace from Tuffier’s lines than women. This can be explained due to difference in anatomical structure of pelvic bone where the anatomy of the female pelvic bone is wider thus iliac crest in women is shorter than men. There was also a significant relationship between heights to the distance of L4-L5 interspace from the Tuffier’s line. It can be concluded that the taller the height of a person then the longer the distance of L4-L5 interspace from the Tuffier’s line. This is in accordance with previous research that subjects with longer height will have a Tuffier’s line that intersect in L4, while a shorter height will intersect in L5. From the results of linear regression analysis above, it is shown that the influence between sex and height to distance of L4-L5 interspace from Tuffier’s line has a moderate correlation.
1. There is a relationship between sex and height to the distance of L4-L5 interspace from the Tuffier’s line.
2. The formula to predict the distance of L4-L5 interspace from Tuffier’s line among Malay adult is 4.921 + [0.536 x (1 for male or 2 for female)] + (-0.052 x height in cm)