The ligamentum nuchae is the thick fibroelastic sagittal septum of the posterior neck, running from the external occipital protuberance and occipital crest to the C7 spinous process. It represents the enlarged supraspinous and interspinous ligament system of the cervical spine and provides a septum dividing the bilateral posterior cervical musculature.
Limits cervical flexion; passive support of the head in the neutral position; midline attachment for trapezius, splenius capitis, and semispinalis capitis.
The nuchal ligament is the primary midline landmark in posterior cervical approaches, where the avascular midline raphe allows splitting without significant bleeding. Whiplash injury may produce nuchal ligament tears visible on MRI as high signal within the posterior midline structures. Calcification of the nuchal ligament (enthesopathy) occurs in ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis (DISH). The ligament is divided in laminoplasty procedures.
Hyperflexion rupture of the nuchal ligament producing midline posterior neck pain and MRI signal change in the nuchal ligament, contributing to chronic post-whiplash neck pain and instability.
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