Evaluati̇on of the tuffi̇er's li̇ne by ultrasound according to age and gender groups

Objective: We aim to compare the effect of age and gender changes on the Tuffier's line and the palpation technique with the Ultrasound technique in determining the correct vertebral level. Materials and Methods : 180 patients were included in this prospective study. The patients were divided into two groups as females (n = 90) and males (n = 90). Each group was classified as young (18-40 years old), middle (40-65 years old) and old (65-80 years old) . All of them have had an ultrasound scan in sitting position in order to confirm the Tuffier's line vertebral level which was diagnosed by palpation. Demographic characteristics of the patients, palpation and Tuffier's line vertebral level determined by ultrasound were recorded. Results: It has been confirmed that Tuffier's line which was identified by palpation technique is in the same level with in 56.6 % of patients that have had an ultrasound scan. In none of the patients the level that has been detected by ultrasound is lower than done Tuffier's line detected by palpation. There has been no significant difference between males and females. There is a negative correlation in Tuffier's line vertebral level in terms of age, BMI and weight (p = 0.001). It has been determined that Tuffier's line is in higher levels in older ages. Also in ultrasound the level is higher in the middle ages and the old. We have found that 33 patients (%18.3) which were graded as L3 and higher, are in risk group during neuraxial block in terms of spinal cord injury. This risk is same in women and men. This risk is 6 times more common in middle aged when compared with youngers (OR [95% CI]= 5.8 [1.21-27.73]) (p= 0.028). In older group this risk is 15 times more common when compared the younger ones (OR [95% CI]= 15.62 [3.46-70.41]) (p = 0.000). As a consequences that it can be said that the risk of spiral cord injuires is much more in higher ages and BMI. Discussion and Conclusion: It has been observed that in sitting position the vertebral level of the Tuffier's line is higher in older ages, moreover BMI and weight are important factors. However, it's not about sex. It should be kept in mind that puncture level may be higher than expected especially in old people. If possible, ultrasound technique should be used for these blocks.