Supracristal Plane: Is it an accurate predictor of the aortic bifurcation or the caval confluence?

Abstract

An accurate knowledge of surface anatomy and anatomical planes are imperative to clinical practice. Traditionally anatomical planes are based on cadaveric studies. Radiological imaging creates an opportunity to re‐assess our current knowledge of surface anatomy. One commonly used landmark is the supracristal plane that can also be used to locate the position for needle insertion in the lumbar puncture. This study aimed to assess the location of the supracristal plane in relation to vertebral levels using Computed Tomography (CT) and to determine the structures located at this plane.Materials and MethodsAdult CT scans (n=191, mean age, 52 years; 59% male) in the supine position were analysed to determine the vertebral level of the supracristal plane, aortic bifurcation, inferior vena cava confluence and umbilicus. The incidence of these structures at each vertebral level was correlated with sex and age. Scans (n=31) with distorting pathology and an absence of consensus amongst reporters was excluded.ResultsThe supracristal plane, aortic bifurcation, IVC confluence and umbilicus were most frequently located at L4/5 intervertebral disc (47.5%), lower third of the L4 vertebra (38.1%), lower third of the L5 vertebra (30%) and at the level of the L4 vertebra (28.7%). In only 13% of patients was the aortic bifurcation located at the supracristal plane. Lumabrisation and sacralisation was present in 2 and 3 patients, respectively.ConclusionModern imaging has enabled an evidence‐based prediction of the location of abdominal organs in different populations. It is imperative that this information is assimilated and incorporated in surgical anatomy education.