Distribution of Lumbar Microdiscectomy Cases by Tuffier’s Line Levels
Öz
Objective: The most used method in the surgical treatment of lumbar disc herniation (LDH) is lumbar microdiscectomy (LMD). In this study, we aimed to show the relationship between Tuffier's line (TL), which is widely used in determining the L4-5 distance in lumbar spinal interventions, and LMD levels.
Materials and Methods: In this study, a total of 204 patients who had LMD or had low back pain were reviewed retrospectively. According to the projection of TL at the spine level; it was divided into 5 categories as L4 corpus, L4 lower endplate, L4-5 disc space, L5 upper endplate, L5 corpus. The cases were analyzed according to age, gender, disc level and changes in TL.
Results: 92.1% of the cases were operated at the L4-5 or L5-S1 level. TL was mostly at L5 upper endplate level in women, L4-5 disc space and above in men, and there was a significant relationship between TLs and gender in both groups (p<0.05).
Conclusion: In our study, we found that although TLs were caudally in patients operated at L5-S1 level, they displaced cranially in patients operated at L4-5 level. However, it was observed that LDH development in the lower lumbar region and increased at the upper levels with ageing.
Anahtar Kelimeler
Tuffier, Lumbar disc herniation, Lumbar microdiscectomy, Tuffier çizgisi, Lomber disk hernisi, Lomber mikrodiskektomi
Kaynakça
- Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018; 27(11): 2791-2803
- Hoy D, March L, Brooks P, Blyth F, Woolf A, Bain C, et al. The global burden of low back pain: estimates from the Global Burden of Disease 2010 study. Ann Rheum Dis. 2014; 73(6): 968-74
- Lagerbäck T, Fritzell P, Hägg O, Nordvall D, Lønne G, Solberg TK, et al. Effectiveness of surgery for sciatica with disc herniation is not substantially affected by differences in surgical incidences among three countries: results from the Danish, Swedish and Norwegian spine registries. Eur Spine J. 2019; 28(11): 2562-2571
- Gregory D.Schroeder, MDChristine A.GuyreBS, Alexander R.VaccaroMD, PhD. The epidemiology and pathophysiology of lumbar disc herniations. Seminars in Spine Surgery . 2016; 28: 2-7
- Roussouly P, Pinheiro-Franco JL. Biomechanical analysis of the spino-pelvic organization and adaptation in pathology. Eur Spine J. 2011; 20 Suppl 5: 609-18
- Tuffier T. The treatment of chronıc empyema. Ann Surg. 1920; 72(3): 266 87
- Chowdhury A, Sharma H. A review of 571 radiographs on Tuffier's inter-cristal line and its' application in lumbar spinal surgery. J Spine Surg. 2018; 4(2): 383-387
- Cooperstein R, Truong F. Systematic review and meta-analyses of the difference between the spinal level of the palpated and imaged iliac crests. J Can Chiropr Assoc. 2017; 61(2): 106-120
- Snider KT, Kribs JW, Snider EJ, Degenhardt BF, Bukowski A, Johnson JC. Reliability of Tuffier's line as an anatomic landmark. Spine (Phila Pa 1976). 2008; 33(6): 161-5
- Endo K, Suzuki H, Tanaka H, Kang Y, Yamamoto K. Sagittal spinal alignment in patients with lumbar disc herniation. Eur Spine J. 2010; 19(3): 435-8