The ligamentum nuchae is the cervical equivalent of the supraspinous and interspinous ligaments, forming a fibrous septum from the inion to C7 that acts as part of the posterior cervical tension band and as the attachment for cervical extensor muscles. In acute whiplash, the nuchal ligament may be disrupted producing persistent posterior cervical pain.
| Origin | External occipital protuberance and median nuchal line |
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| Insertion | Spinous processes of C1-C7 (supraspinous ligament equivalent in the cervical spine) |
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Limits cervical flexion and provides a midline attachment for the posterior neck muscles.
The nuchal ligament is assessed by tenderness along the spinous process tips in posterior cervical pain. Its disruption in hyperflexion injuries produces the midline posterior cervical tenderness of ligamentous sprain. MRI signal in the nuchal ligament identifies higher-grade disruptions. In posterior cervical surgery the incision passes through its relatively avascular midline, splitting the left and right paraspinal muscles.
Hyperflexion disruption producing midline posterior cervical pain managed with soft collar and physiotherapy.
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