The ligamentum nuchae is the cervical continuation of the supraspinous and interspinous ligaments, a triangular sagittal septum running from the external occipital protuberance and median nuchal line to the cervical spinous processes. It separates the left and right posterior neck muscles and gives them attachment. In humans it is mostly fibrous with modest elastic content, whereas in grazing quadrupeds it is a large elastic ligament that holds up the head.
| Origin | External occipital protuberance and median nuchal line |
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| Insertion | Posterior tubercle of the atlas and spinous processes of C2-C7 |
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Limits cervical flexion and provides a midline attachment for the posterior neck muscles.
Calcification or ossification of the ligamentum nuchae is a common incidental finding on lateral cervical radiographs in older adults and is also seen in DISH and ankylosing spondylitis. Its midline is a relatively avascular plane used in posterior cervical approaches to split the left and right muscle groups. Whiplash injuries can stretch or tear the nuchal ligament and adjacent facet capsules, and MRI may show signal change, contributing to persistent posterior cervical pain.
Stretching or tearing of the nuchal ligament during whiplash flexion injury producing midline posterior neck pain and tenderness, managed conservatively with early mobilisation.
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