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Nuchal, Supraspinal & Interspinal Ligaments

The nuchal, supraspinal, and interspinal ligaments lie in the midline and attach to the dorsal structures of the spine. Due to the common position, these ligaments also share the common biomechanical function – the prevention of the hyperflexion of the spine. Moreover, all these ligaments serve as an attachment point for multiple muscles and aponeuroses1–2.

  • 1 Putz R. The detailed functional anatomy of the ligaments of the vertebral column. Annals of Anatomy – Anatomischer Anzeiger, 1992, 174(1):40–47.
  • 2 Aspden R, et al. Collagen organisation in the interspinous ligament and its relatioinship to tissue function. J Anat, 1987, 155:141-151.
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    Icon of crossfade image Nuchal, supraspinal, interspinal and yellow ligaments. Multiple views of the spine.
    Nuchal, supraspinal, interspinal and yellow ligaments. Multiple views of the spine.
    The spine with occipital bone, intervertebral discs, yellow ligaments, the nuchal, interspinal and supraspinal ligaments. The lateral, oblique and posterior view.
    → The nuchal ligament attaches to the cervical spine (inconsistently1 the spinous processes of C2-C7 + dorsal arch of C1) and occipital bone (external occipital crest + external protuberance)
    → The supraspinal ligament connects the tips of the spinal processes from C7 to L3–L4. An extension of the ligament up to the spinous process of L5 occurs in only 5% of individuals.2.
    → The interspinal ligaments are located between spinal processes of the lower thoracic and lumbar spine. There is limited evidence that the interspinous ligaments are absent throughout the upper thoracic spine and are substituted by the thin layer of loose connective tissue3.
  • 1 Mercer S, Bogduk N. Clinical anatomy of ligamentum nuchae. Clin Anat, 2003, 16(6):484–493.
  • 2 Rissanen P. The surgical anatomy and pathology of the supraspinous and interspinous ligaments of the lumbar spine with special reference to ligament ruptures. Acta Orthop Scand Suppl. 1960, 46:1–100
  • 3 Johnson G, Zhang M. Regional differences within the human supraspinous and interspinous ligaments: a sheet plastination study. Eur Spine J, 2002, 11(4):382–388
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    Icon of crossfade image Nuchal ligament and the cervical spine. Lateral view
    Nuchal ligament and the cervical spine. Lateral view
    The cervical spine with the ligamentum nuchae. The lateral view.
    The nuchal ligament is an integral part of neck muscles, i.e., it is made by the aponeuroses of the trapezius, splenius capitis, rhomboideus minor, and serratus posterior superior muscles1. The strongest portion of the ligament – the so-called dorsal raphe – is the fibrous cord extending from the spinous process of C7 to the external occipital protuberance2.
    There is growing evidence that the fibers of the nuchal ligament and the fibers of neck muscles joining the suboccipital portion of the nuchal ligament attach to the cervical dura mater via the atlantooccipital and atlantoaxial interspaces3–5. These fibers, therefore, may directly affect the shape of the spinal dura mater during the motion of the head and neck.
  • 1 Johnson G, et al. The fine connective tissue architecture of the human ligamentum nuchae. Spine, 2000, 25(1):5–9
  • 2 Mercer S, Bogduk N. Clinical anatomy of ligamentum nuchae. Clin Anat, 2003, 16(6):484–493.
  • 3 Zheng N, et al. Definition of the to be named ligament and vertebrodural ligament and their possible effects on the circulation of CSF. PLoS One, 2014, 1;9(8):e103451
  • 4 Dean N, Mitchell, B. Anatomic relation between the nuchal ligament (ligamentum nuchae) and the spinal dura mater in the craniocervical region. Clin Anat, 2002, 15(3):182–185.
  • 5 Humphreys B, et al. Investigation of connective tissue attachments to the cervical spinal dura mater. Clin Anat, 2003, 16:152–159.
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    Icon of crossfade image Thoracolumbar spine with the interspinal & supraspinal ligaments, yellow ligaments and intervertebral discs
    Thoracolumbar spine with the interspinal & supraspinal ligaments, yellow ligaments and intervertebral discs
    The lumbar spine with the supraspinal and interspinal ligaments. The lateral view.
    The size of the supraspinal ligament decreases craniocaudally, and the ligament is rarely seen below the level of L41. This may be related to the need for an increased range of flexion in the lower lumbar spine that otherwise would be significantly restricted2.
    In the lumbar spine, the ventral part of each interspinal ligament splits into the right and left lamina, which merges with the capsular ligaments of the zygapophyseal joints and yellow ligaments3,4.
  • 1 Rissanen P. The surgical anatomy and pathology of the supraspinous and interspinous ligaments of the lumbar spine with special reference to ligament ruptures. Acta Orthop Scand Suppl. 1960, 46:1–100.
  • 2 Heylings D. Supraspinous and interspinous ligaments of the human lumbar spine. J Anat, 1978, 125(1):127–131.
  • 3 Yahia L, et al. Ultrastructure of the human interspinous ligament and ligamentum flavum. A preliminary study. Spine, 1990, 15(4):262–268.
  • 4 Johnson G, Zhang M. Regional differences within the human supraspinous and interspinous ligaments: a sheet plastination study. Eur Spine J, 2002, 11:382–388.
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    Lumbar spine with the interspinal, supraspinal, yellow ligaments and the intervertebral discs.
    Lumbar spine with the interspinal, supraspinal, yellow ligaments and the intervertebral discs
    The lumbar spine with the interspinal ligaments. The lateral view.
    Please note the nearly horizontally directed path of collagen fibers of the interspinal ligament at the lumbar level1. This arrangement of ligament fibers reduces the resistance to the flexion of the lumbar spine compared to the longitudinally oriented ligaments of the spine2. The fibers of the interspinal ligament cranially from the lumbar level gradually become thinner, and fibers' orientation becomes less regular3. In the upper thoracic spine (T1–T5-6), the interspinal ligaments may not be present4.
  • 1 Mahato N. Anatomy of lumbar interspinous ligaments: attachment, thickness, fibre orientation and biomechanical importance. Int. J. Morphol, 2013, 31(1):351–355.
  • 2 Iwanaga J, et al. Anatomical and biomechanical study of the lumbar interspinous ligament. Asian J Neurosurg, 2019, 14(4):1203–1206.
  • 3 Putz R. The detailed functional anatomy of the ligaments of the vertebral column. Annals of Anatomy – Anatomischer Anzeiger, 1992, 174(1):40–47.
  • 4 Johnson G, Zhang M. Regional differences within the human supraspinous and interspinous ligaments: a sheet plastination study. Eur Spine J, 2002, 11:382–388.
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    First published: 28/Aug/2021