title: Ultrasound measurement of the vertebral level of Tuffier's line in elderly women.
abstract: BACKGROUND
  It would be imprecise to generalize the vertebral level determined by palpation to patients of all ages. The purpose of this study was to compare the vertebral level passed by Tuffier's line in elderly women with that passed in adult women using ultrasound in the left lateral decubitus flexed position.
  
  
  METHODS
  We enrolled 50 female patients over the age of 65 (elderly group) and 50 female patients between ages 20 and 50 (control group) who had been scheduled to undergo spinal anesthesia. Using ultrasound, we marked the L2-5 lumbar spinous processes and intervertebral spaces. The most cephalad part was labeled 1 and the most caudal part was labeled 11. We then identified which line of these vertebral levels Tuffier's line crossed.
  
  
  RESULTS
  The median value of the numbers signifying the vertebral level of Tuffier's line was 3 (the L2-3 intervertebral space) in the elderly group, while it was 8 (the lower part of the L4 vertebra) in the control group. The vertebral level of Tuffier's line had statistically significant correlations with age, body mass index, and weight in the elderly group (P < 0.001).
  
  
  CONCLUSIONS
  The vertebral level of Tuffier's line determined with ultrasound measurement in the left lateral decubitus flexed position was more cephalad in the elderly women than in those of the control group. Therefore, we should consider that the needle could be inserted at a higher level than expected, and use care in determining the level of needle insertion during spinal anesthesia in elderly women.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Eun Hee
authors.identifier: 0000-0002-8651-0479
authors.initials: EH
authors.lastname: Chun
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Jee Eun
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Dong Yeon
authors.identifier: 0000-0002-4414-5653
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Youn Jin
authors.identifier: 0000-0001-9189-5839
authors.initials: YJ
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Jong Hak
authors.identifier: 0000-0002-9840-6740
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Rack Kyung
authors.identifier: 0000-0003-4216-1665
authors.initials: RK
authors.lastname: Chung
authors.affiliation: Department of Anesthesiology and Pain Medicine, Ewha Womans University School of Medicine, Seoul, Korea.
authors.forename: Jong In
authors.identifier: 0000-0002-8231-7161
authors.initials: JI
authors.lastname: Han
keywords: Geriatrics; Spinal anesthesia; Spine; Ultrasonography