Ligaments of the Spine

Anatomy > Ligaments > Ligaments of the Spine

The vertebral column (spine) is supported by an extensive network of ligaments (strong connective tissue connecting one bone to another), without which we would lack the stability to perform everyday movements and functions.

Anatomy of the Lumbar Spine

Figure 1 – Anatomy of the Lumbar Spine

Ligaments of the Vertebral Column

From front to back (anterior to posterior) these ligaments include:

Anterior Longitudinal Ligament

This broad, fibrous ligament originating from the base of the skull, covers the anterior aspect of the vertebral bodies and discs from C1 to the sacrum. In maintains intervertebral joint stability and prevents hyperextension.

Posterior Longitudinal Ligament

Extending from the base of the skull and C2 to the sacrum, this ligament connects the posterior aspects of the vertebral bodies and discs. Hence, it runs in the vertebral canal. This helps with the prevention of posterior disc protrusion (disc bulge) as well as hyperflexion of the vertebral column. It is narrower and weaker than the anterior longitudinal ligament.

Ligamentum Flavum

This ligament is unique in that 80% of its fibres are elastic. As we flex (bend forwards), these fibres are stretched. As we return to neutral, these fibres recoil. This elasticity is crucial to prevent bunching of fibres and consequent spinal cord compression. Ligamentum flavum also has a role in preserving spinal curvature. It is present the entire vertebral column with fibres running from lamina to lamina of each vertebral level, with some fibres extending into the (zygapophyseal) facet joints.

Intertransverse Ligament

This thin ligament runs between the transverse processes of the vertebral column, one segment at a time. It often blends in with the intertransversarii muscles (see lumbar vertebrae). Its role is to limit lateral flexion (side bending) by restricting separation of the transverse processes.

Interspinous Ligament

This ligament is composed of thin sheets connecting the spinous processes (from roots to apexes) from C1-S1 one segment at a time. Anteriorly, its fibres connect with ligamentum flavum, whilst posteriorly its fibres connect with the supraspinous ligament. The role of the interspinous ligament is to limit flexion (bending forwards) through restricting separation of the spinous processes of the vertebral column.

Supraspinous Ligament

This ligament attaches to the apex of the spinous processes and spans 2-5 vertebrae at a time. It is long and thick with fibres running vertically, starting at C7 and finishing at the sacrum. (Above the level of C7 an extension of this ligament is known as ligamentum nuchae). The internal / anterior fibres of the supraspinous ligament connect with the interspinous ligament. Its role is to limit flexion of the vertebral column. It also has an important role acting in a reflex arc with the multifidus muscle (an important stabilizing muscle). When the supraspinous ligament is placed on stretch (in flexion), this activates mechanoreceptors (detectors of movement) which in turn activate the multifidus to contract and support the spine.

Other Ligaments of the Spine

Mamillo-Accessory Ligament

This ligament runs from the mamillary process to the accessory process of vertebrae, enclosing the medial arch of the dorsal rami in an osseofibrous tunnel.

Transforaminal Ligament

This ligament is more fascial (connective tissue) as opposed to a true ligament. Its narrow bands of collagen transverse the foramina close to the nerve root. This ligament may sometimes be a source of nerve root compression as it tracks downwards as intervertebral disc height reduces with age or through degeneration.

Ligaments and Membranes Specific to the Cervical Spine

Spinal Ligaments

Ligamentum Nuchae

This ligament runs from the occipital protuberance (base of skull) to C7 (lowest vertebra of the neck). It is an extension of the supraspinous ligament and helps prevents cervical hyperflexion.

Ligaments of the Atlanto-Occipital Joint

Alar Ligaments

Running from the dens (C2) to the lateral aspects of the foramen magnum (skull), this pair of ligaments limits ipsilateral head rotation and contralateral side flexion.

Apical Ligament

Running from the apex of the dens (C2) to the foramen magnum (skull), this ligament limits separation of the dens from the occiput (skull), hence stabilizing both the atlanto (C1) – occipital (skull) and the atlanto (C1) – axial (C2) articulations.

Techtorial Membrane

Lying within the vertebral canal, this is considered to be a superior continuation of the posterior longitudinal ligament. It extends from the vertebral body of C1 to the occiput covering the alar and transverse ligaments. This ligament limits forward flexion.

Transverse Ligament

As its name suggests, the fibres of the transverse ligament run horizontally. They connect the two lateral masses of the Atlas (C1) spanning the anterior vertebral foramen, hence, holding the dens (C2) in close approximation with the atlas. The transverse ligament resists anterior translation of the atlas relative to the axis and is an integral stabilizer of the atlanto-axial joint (C1/C2). It is also part of the cruciform ligament complex.

Cruciform Ligament

The cruciform ligament is composed of (1) the transverse ligament and (2) the superior and inferior longitudinal bands. Together they make a ‘cross’ appearance.

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