The anatomy of intermuscular cellular spaces in the context of errector spinae fascial plane anesthesia: a literature review

Abstract

Background. Cellular spaces, also referred to as interfascial planes, represent anatomical compartments formed by loose connective tissue and delimited by fasciae, muscles, bones, and other structural elements. These spaces may contain blood vessels, nerves, and lymph nodes and play an important role in facilitating the mobility and interaction of anatomical structures. In pathological conditions, particularly infectious processes, they can also serve as pathways for the spread of purulent collections. Recent anatomical and imaging studies have redefined the cellular space as the plane between two layers of the deep fascia, composed primarily of adipose tissue, elastin, and reticular fibers. In recent years, these interfascial planes have gained increasing importance in regional anesthesia, particularly in the development of fascial plane blocks, which are widely used due to their safety and technical simplicity. Aim of the study. The aim of this study was to highlight the anatomical and clinical significance of interfascial cellular spaces, with particular emphasis on the erector spinae plane, and to underline their relevance in the performance of fascial plane blocks used for postoperative and chronic pain management. Results. The analysis of the anatomical characteristics of the erector spinae interfascial plane demonstrates that this space is located between the erector spinae muscle and the transverse processes of the vertebrae. Within this plane run the dorsal and ventral rami of the spinal nerves, which can be effectively anesthetized following the administration of local anesthetic. The spread of the anesthetic solution occurs both cranially (approximately 1–3 vertebral levels) and caudally from the injection site, allowing the blockade of multiple dermatomes. This anatomical distribution explains the effectiveness of the erector spinae plane block in providing analgesia for a variety of surgical procedures as well as for the treatment of acute and chronic pain conditions. Conclusion. A thorough understanding of topographic anatomy and interfascial cellular spaces is essential for performing medico-surgical procedures with minimal complications. The evolution of fascial plane blocks from landmark-based techniques to ultrasound-guided approaches has significantly increased their safety and accuracy. Consequently, locoregional anesthesia techniques, particularly fascial plane blocks such as the erector spinae plane block, are expected to gain wider applicability across both surgical and therapeutic medical specialties.