Abstract
Background This study aimed to determine whether the iliac crests are truly at the level of L4 to L5, accounting for patient demographic and anthropometric characteristics.
Methods We measured the umbilicus and iliac crests relative to the lumbar spine using computed tomography of patients without spinal pathology, accounting for the influences of patient height, weight, body mass index (BMI), sex, race, and ethnicity.
Results A total of 834 patients (391 men and 443 women) were reviewed. The location of the umbilicus relative to the lumbar spine demonstrated a unimodal distribution pattern clustered at L4, while the iliac crests were most frequently located from L4 to L5. Iliac crests were located above the L4 to L5 disc space 26.5% of the time. Iliac crests were located at the L4 to L5 disc space 29.8% of the time. No correlations were observed between the umbilicus and iliac crests with patient height, weight, or BMI. There was no difference in the location of the umbilicus with respect to patient sex, race, and ethnicity. The locations of the iliac crests were cephalad in women compared with men and in Hispanics compared with African American, Caucasian, and Asian patients.
Conclusions The iliac crests were located above the level of the L4 to L5 disc space approximately 26% of the time. The umbilicus is most frequently at the level of the L4 vertebral body. Patient height, weight, and BMI do not influence the location of the umbilicus or the iliac crests relative to the lumbar spine. Patient sex and ethnicity influence the location of the iliac crests but not the umbilicus relative to the lumbar spine.
Clinical Relevance Modern neurosurgical techniques require clearance of the iliac crests during anterior and anterolateral approaches. Understanding the level of the iliac crests is crucial in planning for transpsoas fusion approaches.
Level of Evidence 2.
Footnotes
Funding The authors received no financial support for the research, authorship, and/or publication of this article.
Declaration of Conflicting Interests The authors report no conflicts of interest in this work.
Disclosures Olumide Danisa reports grants/contracts from NuVasive and the Musculoskeletal Transplant Foundation (MTF); consulting fees from Stryker Spine and Spine Art; support for attending meetings/travel from the American Board of Orthopedic Surgery and the MTF; serving on committees for North American Spine Society, Orthopedic Research Society, and American Academy of Orthopedic Surgeons; and serving as an associate editor for SpineLine and NASSJ. Wayne Cheng reports grants or contracts from DePuy; consulting fees from Medtronic and Orthofix; and payment/honoraria for lectures, presentations, speakers bureaus, manuscript writing, or educational events from Orthofix and Radius. The remaining authors have nothing to disclose.
Data Availability Statement The datasets used and/or analyzed during the current study are included in this published article and are available from the corresponding author on reasonable request.
- This manuscript is generously published free of charge by ISASS, the International Society for the Advancement of Spine Surgery. Copyright © 2024 ISASS. To see more or order reprints or permissions, see http://ijssurgery.com.
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