The cervical ligamentum flavum has the highest elastin content of any spinal ligament — nearly 80% elastin — maintaining tension in neutral position and preventing buckling during extension. Its hypertrophy from cervical spondylosis contributes to cervical central canal stenosis alongside disc herniation and osteophytes. Calcification of the flavum (more common in the thoracic spine but occasionally cervical) can produce epidural calcification visible on CT.
| Origin | Anterior-inferior surface of the upper cervical lamina |
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| Insertion | Posterior-superior surface of the lower lamina and articular process |
| Actions | Elastic recoil restoring cervical neutral from flexion; the largest flavum fibres are at C3-C4 (highest cervical motion segment loads) |
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Cervical myelopathy from combined anterior disc-osteophyte complex and posterior ligamentum flavum hypertrophy produces the 'pincer' compression pattern on T2 MRI — high signal in the cord between anterior and posterior compressive elements. Laminoplasty (hinge-type laminar expansion) decompresses the cord from behind by enlarging the canal capacity, expanding both the central and lateral portions.
Posterior canal encroachment from flavum thickening contributing to cervical myelopathy managed with laminoplasty or laminectomy.
