Tame Simon J, Burstal Richard
Department of Anaesthesia, Intensive Care and Pain Management, John Hunter Hospital, Hunter Region Mail Centre, NSW, Australia.
Paediatr Anaesth. 2003 Oct;13(8):676-80. doi: 10.1046/j.1460-9592.2003.01120.x.
The inability of anaesthetists to accurately identify vertebral spaces has been documented. The aim of our magnetic resonance imaging (MRI) study was to find the relationship of vertebral body level with Tuffier's line and the conus medullaris in children.
Forty-nine children aged 10 years or less who had MRI scanning in the region of the lumbar spine were identified. If either the conus medullaris or iliac crests were visible, the corresponding vertebral body level was recorded.
The level of the conus could be identified in 43 patients. The median conus level was at L1 with an interquartile range (IQR) of 0.5 vertebral levels. The level of the crests could be identified in 35 patients. The median crest height was L5 with an IQR of 0.5 vertebral levels. The difference between conus and crest levels could only be calculated in 29 patients. In the remainder of the children one of the two pieces of the data was not available. The median difference was 4 vertebral levels with an interquartile range (IQR) of 1. Two of 49 children, both of whom had tethered cords, had differences of <2 vertebral levels.
Our data confirmed that the iliac crests and conus medullaris were consistently related to the predicted vertebral levels in children. In the absence of a tethered spinal cord, subarachnoid puncture at L4-5 or below should present little risk of conus damage. Tuffier's line corresponded with a radiological level of L4-L5 in our study population.
已有文献记载麻醉医生无法准确识别椎间隙。我们的磁共振成像（MRI）研究目的是找出儿童椎体水平与图菲埃线及脊髓圆锥的关系。
确定49名10岁及以下在腰椎区域进行MRI扫描的儿童。如果能看到脊髓圆锥或髂嵴，则记录相应的椎体水平。
43例患者可确定脊髓圆锥水平。脊髓圆锥的中位水平在L1，四分位间距（IQR）为0.5个椎体水平。35例患者可确定髂嵴水平。髂嵴的中位高度在L5，IQR为0.5个椎体水平。仅29例患者可计算脊髓圆锥和髂嵴水平的差异。其余儿童中，两项数据之一不可用。中位差异为4个椎体水平，IQR为1。49名儿童中有2名患有脊髓栓系综合征，其差异均<2个椎体水平。
我们的数据证实，髂嵴和脊髓圆锥与儿童预期的椎体水平始终相关。在没有脊髓栓系的情况下，在L4 - 5或更低水平进行蛛网膜下腔穿刺对脊髓圆锥造成损伤的风险应该很小。在我们的研究人群中，图菲埃线对应于L4 - L5的放射学水平。
