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ORIGINAL ARTICLE
Year : 2016  |  Volume : 3  |  Issue : 2  |  Page : 34-39

Clinical methods of spinal-level localization in lumbar and lumbosacral spine surgeries through posterior approach


1 Assistant Professor, Department of Neurosurgery, Institute of Human Behaviour and Allied Sciences, Delhi, India
2 Senior Resident, Department of Neurosurgery, Institute of Human Behaviour and Allied Sciences, Delhi, India
3 Associate Professor, Department of Neuroanesthesia, Institute of Human Behaviour and Allied Sciences, Delhi, India
4 Assistant Professor, Department of Neuroanesthesia, Institute of Human Behaviour and Allied Sciences, Delhi, India
5 Associate Professor, Department of Neurology, Institute of Human Behaviour and Allied Sciences, Delhi, India
6 Associate Professor, Department of Neuroradiology, Institute of Human Behaviour and Allied Sciences, Delhi, India

Correspondence Address:
Deepak K Jha
Assistant Professor Department of Neurosurgery, Institute of Human Behaviour and Allied Sciences, Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.5005/jp-journals-10039-1083

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Aims: Clinical methods of palpations of iliac crests and spinous processes for spinal-level localization (SLL) were evaluated for accuracy in lumbar and lumbosacral (LS) spinal surgeries through the posterior approach. Materials and methods: Hundred and seven successive patients operated for lumbar and LS diseases operated through the posterior approach in the last 2 years were evaluated prospectively for the accuracy of clinical methods for SLL. There were 76 males and 31 females. Age ranged from 16 to 70 years (average 43.5 years). Clinical methods for SLL included palpation of iliac crests and spinal processes in correlation with midline sagittal MR images. Surgical incision and further surgery were undertaken after confirmation of spinal level by intraoperative lateral radiograph of LS spine. Accuracy of SLL by clinical methods and surgical findings at various spinal levels was observed. Results: Spinous processes for SLL were accurate in 94.39% (n = 101) cases. The level of iliac crests were seen at or just below L3 and L4 spinous processes in 89.71% (n = 96) and 10.29% (n = 11) cases respectively. Various anatomical features like posterior surfaces of laminae, thecal sac, and positions of roots in the spinal canal were helpful in differentiating L5 to S1 level than levels above. Six errors in SLL in the study included five females with L4 to L5 prolapsed inter-vertebral disk (PIVD) and one male with L5 to S1 PIVD. Conclusion: Spinal-level localization by clinical methods in correlation with MR images is unreliable especially in women and L4 to 5 level. Intraoperative findings of L5 to S1 interspace and S1 lamina show features that may help in SLL during surgery.


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