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Topography of fascia and cellular spaces of the back
Last reviewed: 19.10.2021
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In a living person, the external occipital protrusion, the spinous processes of the II and VII cervical, all thoracic and lumbar vertebrae, and the middle sacral crest are distinctly palpable. Cervical and lumbar lordosis, thoracic and sacral kyphosis are defined. On each side of the spinal column, ribs, scapula, medial margin and the lower angle of the scapula are probed. On the sides of the midline, the muscles that straighten the spine are determined. These muscles are easily palpable.
The skin of the back is thick, it is soldered by means of connective tissue bundles with a superficial fascia. There are a lot of sebaceous and sweat glands in the skin. Subcutaneous fat is well expressed especially in women, it has the back branches of the intercostal blood vessels, nerves, branches of the transverse arteries of the neck and shoulder blade.
The superficial fascia covering the trapezius and the widest back muscles is weakly expressed. In the lumbar region under the superficial fascia lies the lumbar and gluteal fat mass, which covers the lower extremities of the latissimus muscles of the back.
The lumbosacral fascia (fascia thoraco-lumbalis) is well developed, which covers the deep muscles of the back. This fascia is best represented in the lumbar region, where it is clearly split into two plates. The superficial plate of the lumbosacral fascia is attached to the spinous processes of the lumbar vertebrae, the basted ligaments, the median sacral ridge, the outer lip of the iliac crest and the superior posterior iliac spine. Laterally the surface lamina fuses with the deep plate of this fascia, forming a bone-fascial bed for the muscle that straightens the spine. With the superficial plate, the tendon ligament (aponeurosis) of the latissimus muscle of the back is firmly fused.
The deep plate of this fascia on the medial side is attached to the transverse processes of the lumbar vertebrae and the interdigitinal ligaments, at the bottom to the iliac crest, at the top to the lower edge of the XII rib. The thickened upper edge of the deep plate, stretched between the transverse process of the I lumbar vertebra and the XII rib, is called the lumbar-rib bundle. In the lumbar region, a deep plate separates the muscle that straightens the spine from the square muscle of the waist.
In the chest area, the surface plate of the lumbosacral fascia is attached to the spinous processes of the thoracic vertebrae, laterally to the corners of the ribs. In the back (neck) area of the neck between the muscles there is a fascia michae, the leaves of which separate the occipital muscles from each other.
In front of the trapezius muscle and the broadest muscle of the back, which partially cover the scapula, is a loose fiber that separates these muscles from the belt muscles of the head and neck, the muscle that lifts the scapula, the rhomboid and jagged muscles.
In the back of the occipital region is the occipital triangle, bounded by a large posterior straight line and oblique muscles of the head. At the bottom of this triangle, under the fascia and cellulose, is the posterior arch of the atlant. Between the posterior arch of the atlas and the occipital bone there is a dense posterior atlanto-occipital membrane.