The supraspinous ligament at the L4-L5 level connects the tips of adjacent spinous processes and blends with the posterior layer of the thoracolumbar fascia. At L4-L5 it is the ligamentous structure most commonly encountered during midline posterior lumbar approaches.
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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