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Topography of fasciae and cellular spaces of the back
Last reviewed: 06.07.2025
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In a living person, the external occipital protuberance, spinous processes of the second and seventh cervical, all thoracic and lumbar vertebrae, and the middle sacral crest are clearly palpable. Cervical and lumbar lordosis, thoracic and sacral kyphosis are determined. The ribs, scapular spine, medial edge and lower angle of the scapula are palpable on the sides of the spinal column. The muscles that straighten the spine are determined on the sides of the midline. These muscles are easily palpable.
The skin of the back is thick, it is fused with the help of connective tissue bundles with the superficial fascia. The skin contains many sebaceous and sweat glands. The subcutaneous tissue is well expressed, especially in women, in it pass the posterior branches of the intercostal blood vessels, nerves, branches of the transverse arteries of the neck and scapula.
The superficial fascia covering the trapezius and latissimus dorsi muscles is weakly expressed. In the lumbar region, under the superficial fascia lies the lumbogluteal fat mass, which covers the lower edges of the latissimus dorsi muscles.
The thoracolumbar fascia (fascia thoracolumbalis) is well developed and covers the deep muscles of the back. This fascia is best represented in the lumbar region, where it clearly splits into two plates. The superficial plate of the thoracolumbar fascia is attached to the spinous processes of the lumbar vertebrae, supraspinous ligaments, median sacral crest, outer lip of the iliac crest and superior posterior iliac spine. Laterally, the superficial plate fuses with the deep plate of this fascia, forming an osteofascial bed for the muscle that straightens the spine. The tendinous origin (aponeurosis) of the latissimus dorsi muscle is firmly fused with the superficial plate.
The deep plate of this fascia is attached medially to the transverse processes of the lumbar vertebrae and the intertransverse ligaments, below to the iliac crest, and above to the lower edge of the 12th rib. The thickened upper edge of the deep plate, stretched between the transverse process of the first lumbar vertebra and the 12th rib, is called the lumbocostal ligament. In the lumbar region, the deep plate separates the erector spinae muscle from the quadratus lumborum muscle.
In the chest area, the superficial plate of the lumbosacral fascia is attached to the spinous processes of the thoracic vertebrae, laterally - to the angles of the ribs. In the posterior (nuchal) region of the neck, between the muscles there is the nuchal fascia (fascia michae), the sheets of which separate the occipital muscles from each other.
In front of the trapezius and latissimus dorsi muscles, which partially cover the scapula, there is loose tissue separating these muscles from the splenius muscles of the head and neck, the levator scapulae, the rhomboids and serratus muscles.
In the depth of the occipital region is the occipital triangle, limited by the large posterior rectus and oblique muscles of the head. At the bottom of this triangle, under the fascia and cellular tissue, is the posterior arch of the atlas. Between the posterior arch of the atlas and the occipital bone is the dense posterior atlanto-occipital membrane.