The supraspinous ligament is a continuous fibrous cord running along the tips of all vertebral spinous processes from the sacrum to C7, where it merges with the nuchal ligament in the cervical spine. It is the most posterior of the spinal ligaments and provides the last passive line of defence against excessive forward flexion of the spine, working alongside the interspinous ligaments, ligamentum flavum, and posterior longitudinal ligament in a complementary system.
| Origin | Spinous process of C7 (merging with the nuchal ligament above) |
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| Insertion | Continuous along the tips of all lumbar and thoracic spinous processes to the sacrum |
| Actions | Resists excessive spinal flexion; provides posterior tension to the vertebral column |
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The supraspinous ligament is the most commonly injured spinal ligament in flexion injuries and whiplash, and its disruption is a sign of significant spinal instability that requires imaging assessment. In elderly patients with osteoporosis, the supraspinous ligament can become calcified and is visible on plain radiographs. Tenderness over the supraspinous ligament at a specific spinal level is used clinically to localise symptomatic levels before intervention.
Tearing of the ligament from sudden or excessive spinal flexion or whiplash, producing midline spinal pain that is exquisitely tender over the involved spinous processes and reproduced by overpressure flexion.
