The lumbar interspinous ligaments are thin membranes filling the space between adjacent lumbar spinous processes, broader and thicker than in the thoracic spine. With the supraspinous ligament, ligamentum flavum and facet capsules they form the posterior ligamentous complex. Interspinous spacer devices (such as X-Stop and Superion) are placed between the spinous processes to limit extension at a stenotic level, and the midline interlaminar route for lumbar epidural injection passes through these ligaments.
| Origin | Inferior border of each lumbar spinous process |
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| Insertion | Superior border of the adjacent lower spinous process |
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Limits separation of adjacent lumbar spinous processes during flexion.
Interspinous process devices are indicated for extension-worsened lumbar stenosis (neurogenic claudication) in selected patients who are not candidates for formal decompression. Baastrup disease (kissing spines) from contact between enlarged spinous processes with interspinous bursitis and fibrosis produces midline low back pain reproduced by extension. After trauma, widening between spinous processes on radiographs or high signal in the interspinous ligament on MRI indicates posterior ligamentous complex injury and an unstable fracture pattern.
Interspinous ligament fibrosis from spinous process contact producing midline extension-worsened pain managed with interspinous injection.
Interspinous ligament tear with spinous process widening after flexion-distraction trauma, indicating instability that usually needs posterior instrumented fusion.
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