The ligamentum nuchae is the cervical equivalent of the supraspinous ligament, a sagittal septum of elastic tissue connecting the occipital protuberance to the cervical spinous processes. Unlike the supraspinous ligament, it contains a high proportion of elastin that allows it to store energy during flexion and return the head to neutral position passively. In quadrupedal mammals it is much larger as an elastic energy-saving mechanism for head support.
| Origin | External occipital protuberance and median nuchal line |
|---|---|
| Insertion | Spinous processes of all cervical vertebrae C2 through C7 |
| Actions | Limits cervical flexion, supports the head against gravity, provides attachment for trapezius, rhomboids, and splenius muscles |
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The ligamentum nuchae calcification is a common incidental finding on lateral cervical radiographs in older adults and is not clinically significant. The ligamentum nuchae is the posterior boundary of the nuchal triangle used as a landmark in posterior cervical spine surgery. Whiplash injuries can stretch or tear the nuchal ligament and adjacent facet capsules, 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.
