The iliolumbar ligament spans the L4-L5 transverse processes to the iliac crest, providing the primary bony restraint against forward slip of L5 on S1 and lateral shear at L4-L5. Its disruption is required for grade III-IV spondylolisthesis to occur. It also blends with the anterior SI joint capsule, providing a ligamentous continuum from the lumbar spine through the SI joint to the pelvis.
| Origin | Transverse processes of L4 and L5 |
|---|---|
| Insertion | Iliac crest and anterior SI joint capsule |
| Actions | Primary restraint against L5 forward slip on S1; resists L4-L5 and L5-S1 lateral shear and flexion |
|---|
The iliolumbar ligament enthesopathy produces iliac crest pain at L4-L5 level — a distinct source of low back pain reproduced by palpation at the iliac crest medial to the PSIS. It may be erroneously attributed to SI joint or facet pathology. Iliolumbar ligament injection targets the insertion on the iliac crest for diagnostic confirmation.
Iliac crest pain from iliolumbar ligament attachment pathology producing low back and crest pain managed with injection and core stabilisation.
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