Body Mass Index Correlates with Skin to Spinal Canal Distance: A Large Retrospective Single-Center Study

Keon Mahmoudi, Young Joon, Shingo Kihira, Jonathan Goldstein, Katherine Laura Garvey, Samantha Platt, Puneet Belani, Brian Rigney, Thomas Naidich, Anthony Costa, Amish Doshi

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


BACKGROUND AND PURPOSE: Despite increasing demand for fluoroscopy-guided lumbar puncture (FG-LP), there is limited quantitative and epidemiological data on patients undergoing this procedure. Additionally, data are scarce on the correlation of iliac crest landmarks to the actual anatomical lumbar level (intercristal line). The aim of this study is to determine if (1) body mass index (BMI) correlates with skin to spinal canal distance (SCD) and (2) the iliac crest landmark correlates with the presumed anatomical landmark on cross-sectional imaging. METHODS: In this retrospective, single-center IRB-approved study, we assessed 495 patients who underwent FG-LP and had lumbar computed tomography/magnetic resonance imaging within 6 months of presentation. SCD was measured on the sagittal view at the L3-L4, L4-L5, and L5-S1 intervertebral levels. RESULTS: In our cohort of 495 adults (mean age ± standard deviation [SD], 53.2 ± 16.4 years), there was a statistically significant linear correlation between BMI and SCD at each intervertebral level. Mean ± SD (R2) SCD at L3-4, L4-5, and L5-S1 was 6.7 ± 1.6 cm (.5486), 7.4 ± 1.9 cm (.5894), and 7.8 ± 1.9 cm (.5968), respectively. The intercristal line aligned with L3-L4, L4-L5, and L5-S1 in 2.1%, 72.4%, and 6.2% of patients, respectively. CONCLUSIONS: There was direct, positive linear correlation between BMI and SCD at clinically relevant lumbar disc levels. Furthermore, there is considerable anatomical variance in the intervertebral space that aligns with the superior aspect of the iliac crest.

Original languageEnglish
Pages (from-to)896-900
Number of pages5
JournalJournal of Neuroimaging
Issue number6
StatePublished - 1 Nov 2020


  • Body mass index
  • fluoroscopy-guided lumbar puncture
  • intercristal line
  • lumbar imaging
  • lumbar puncture
  • skin to spinal canal distance


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