J Med Assoc Thai 2010; 93 (11):1294

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The Position of the Lumbar Vertebrae in Relation to the Intercrestal Line
Wattanaruangkowit P Mail, Lakchayapakorn K

Objective: To determine the position of the lumbar vertebrae in relation to the intercrestal line and variation in distance
between the midpoint of the L4/5 interspinous space and the intercrestal line in varying patients age groups of Thai people.

Material and Method: The present study was a retrospective analysis of the antero-posterior and lateral lumbosacral
vertebral radiographs of 270 patients, varying patients’ age from 20 to 80 years. Intercrestal line was drawn connecting the
two highest points on the iliac crests of antero-posterior radiographs. The distance from the intercrestal line to the midpoint
of the L4/5 interspinous space and L4/5 intervertebral space were measured. The results were statistically analysed by using
ANOVA testing.

Results:
The intercrestal line crosses the midline of the posterior part of the lumbar vertebral column between the upper half
of L4 spinous process level and lower half of L5 spinous process level, most often at the lower half of L4 spinous process level
(101 cases, 37.41%). This line crosses the anterior part of the lumbar vertebral column between the upper half of L4 body
level and lower half of L5 body level, most often at the upper half of L5 body level (103 cases, 38.15%). Regarding distance
from intercrestal line to the midpoint of the L 4/5 interspinous space in varying patient age groups, the intercrestal line
was most frequently found above the L 4/5 interspinous space in most age group (average 5.73 + 5.72 mm; value p > 0.05 vs.
70-80 years). For the distance from intercrestal line to the midpoint of the L 4/5 intervertebral space in varying patient age
groups, the intercrestal line was most frequently found below the L 4/5 intervertebral space in all age groups (average 6.60 +
6.97 mm; value p > 0.05 vs. 70-80 years).

Conclusion: The intercrestal line crosses the posterior part of the lumbar vertebral column between the upper half of L4
spinous process level and lower half of L5 spinous process level, most often at the lower half of L4 spinous process level
(37.41%) and at the L4/5 interspinous space level (27.78%). This line crosses the anterior part of the lumbar vertebral column
between the upper half of L4 body level and lower half of L5 body level, most often at the upper half of L5 body level (38.15%)
and at the L4/5 intervertebral space level (32.22%). The level of the intercrestal line tends to be high in elderly patients, neutral
position and the intercrestal line by palpation tends to be identified at the higher level.

Keywords:
Lumbar vertebrae, Spine, Intervertebral disc, Intercrestal line, Intercristal line Supracristal line, Jacoby’s line,
Tuffier’s line, Iliac crest

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