The iliolumbar ligament connects the L5 (and L4) transverse processes to the iliac crest, acting as the primary stabiliser of the lumbosacral junction against the shear forces that make L5-S1 the most mobile and injury-prone spinal level. It resists the forward translation of L5 on S1 that spondylolisthesis represents. The iliolumbar ligament is divided during iliac crest bone graft harvest from the posterior ilium.
| Origin | L4 and L5 transverse processes |
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| Insertion | Iliac crest and anterior sacroiliac ligament |
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Stabilises L5 on the sacrum and ilium, limiting flexion, lateral flexion and rotation at the lumbosacral junction.
Iliolumbar ligament syndrome produces unilateral deep lower back and pelvic pain that radiates to the groin and anterior thigh (mimicking L4 radiculopathy) from iliolumbar ligament strain or enthesopathy. Prolotherapy or corticosteroid injection at the iliac crest attachment confirms the diagnosis and provides relief.
Iliolumbar ligament enthesopathy producing deep lumbopelvic pain managed with targeted injection at the L5 transverse process-iliac crest attachment.
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