The supraspinous ligament runs along the tips of the spinous processes. In the lower lumbar spine it is variable: it often ends at L3 or L4, and at L4-L5 and L5-S1 it is commonly thin or replaced by the crossing fibres of the thoracolumbar fascia and the tendons of the back muscles.
| Origin | Tip of the L4 spinous process |
|---|---|
| Insertion | Tip of the L5 spinous process, where present |
Resists separation of the spinous processes in flexion
The supraspinous ligament at L4-L5 is a landmark incised in posterior lumbar decompression surgery and preserved in minimally invasive approaches. It receives the insertion of the multifidus muscle fibres at each level. Supraspinous ligament ossification in DISH produces the characteristic flowing bone of the posterior spinous processes. In interspinous device placement (X-Stop), the supraspinous ligament is preserved as the posterior tension band.
Posterior element disruption including the supraspinous ligament from flexion-distraction lumbar injury (Chance fracture pattern), producing ligamentous instability requiring posterior surgical stabilisation.
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