Anatomical Clarification of Superficial and Deep Lumbar ESP Injections Based on the Erector Spinae Fascial Boundary

The back muscles that lie deep into the thoracolumbar fascia are called intrinsic or true back muscles. These muscles are divided into four layers: superficial, intermediate, deep, and deepest layers.
Superficial Layer:
The superficial layer consists primarily of the splenius muscles, which include the splenius capitis and splenius cervicis. These muscles are mainly responsible for the head and cervical spine movements, including extension, rotation, and lateral bending. The splenius capitis...

Body planes in anatomy are imaginary flat surfaces used as reference points to divide the body into sections for anatomical study. These planes are essential for understanding the orientation, relationships, and spatial organization of anatomical structures.
The sagittal plane is the plane that divides the body or an organ vertically into right and left sides. If this vertical plane runs directly down the middle of the body resulting in equal division, it is called the midsagittal or median...

Spinal nerves are pivotal conduits in the nervous system, bridging the central nervous system (CNS) with the peripheral nervous system (PNS). These nerves enable a complex communication network between the brain, spinal cord, and the rest of the body, facilitating sensory input, motor output, and autonomic functions.
There are 31 bilateral pairs of spinal nerves, each emerging from the spinal cord through the intervertebral foramina—openings between adjacent vertebrae. These nerves are...

Directional terms are essential for describing the relative locations of different body structures. For instance, an anatomist might describe one band of tissue as "inferior to" another, or a physician might describe a tumor as "superficial to" a deeper body structure. These terms often use comparative terms in pairs to trace out the relative locations of one body part to another or descriptions of body tissues like the deeper ones from superficially present with reference to...

Fascia, a thin layer of fibrous connective tissue, is distributed throughout the body. It demarcates and forms a supportive covering over skeletal muscles, bones, blood vessels, and organs. There are three main types of facia— superficial fascia, deep fascia, and subserous fascia. These are all present at different depths in the body. Fascia reduces the friction and permits muscles, joints, and organs to easily slide against each other, facilitating movement of the body and preventing...

Spinal anesthetics are given during lower abdomen and limb surgeries to block sensory and motor neurons. They are administered in the mid to low lumbar regions, primarily acting on the cauda equina's nerve roots. The blockade level depends on the local anesthetic (LA) concentration. Usually, low LA concentrations are sufficient to block sensory fibers, while only high LA concentrations block motor fibers. Other factors like injection volume and speed, the patient's posture, and the drug...