Interexaminer Reliability and Accuracy of Posterior Superior Iliac Spine and Iliac Crest Palpation for Spinal Level Estimations

Hye Won Kim, Young Jin Ko, Won Ihl Rhee, Jung Soo Lee, Ji Eun Lim, Sang Jee Lee, Sun Im and Jong In Lee

The purpose of this study was to compare the posterior superior iliac spine (PSIS) and the iliac crest as accurate anatomical landmarks for identifying spinal level.  This study was conducted in 2 stages, firstly examiners examined 60 patients and blindly identified iliac crest and PSIS levels, secondly, examiners attached a radio opaque marker at presumed PSIS and iliac crest levels in 72 patients  which was then cross checked with radiographic identification.  The interexaminer reliability of palpation was significantly greater for PSIS level than for the iliac crest. Spinal levels of estimated PSISs identified by palpation ranged from the L5-S1 interspace to the S2 spinous process, and the spinal levels of estimated iliac crest ranged from the L2-3 interspace to the L5 spinous process.  Although PSIS palpation showed statistically higher interexaminer reliability than iliac crest level, clinicians should be cautious when applying this method as a measurement tool because estimated spinal level by palpation can be influenced inadvertently by examiner skill and anatomical variations.

Journal of Manipulative and Physiological Therapeutics, 2007, 30(5), 386-389

Link to Abstract

Link to Full Text