The intercristal line (also known as Jacobys’s Line or Tuffier’s Line) is a horizontal line drawn across the highest points of both the iliac crests in an anteroposterior (AP) lumbar radiography 1,2
Intercristal line most often intersects the body of the L4 or its inferior endplate in men and the body of L5 or its superior endplate in women. In the general population, the intersection of the intercristal line may vary anywhere between the inferior end plate of the L4 to the superior endplate of the L5.1
Its significance is two fold:
- it is a more accurate method for numbering the lumbar vertebra, and hence
- is an anatomical landmark used to avoid wrong-level spinal surgery or intervention.
History and etymology
Jacoby, an American physician proposed the line in 1895 as a landmark that intersected L4 vertebra. Five years later in 1890, French surgeon T Tuffier described the same line passing through L4/L5 intervertebral disc. Both used the landmark for the purpose of performing lumbar subarachnoid injection 2.
- 1. Snider KT, Kribs JW, Snider EJ et-al. Reliability of Tuffier's line as an anatomic landmark. Spine. 2008;33 (6): E161-5. doi:10.1097/BRS.0b013e318166f58c - Pubmed citation
- 2. Walsh, J.C., Quinlan, J.F., Butt, K. et al. Eur J Orthop Surg Traumatol (2006) 16: 203. doi:10.1007/s00590-005-0075-7 Variation in position of the L4/5 disc inter-space from the anatomical landmark: review of 450 radiographs and clinical applications