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Supraspinous ligament

The supraspinous ligament is a strong, fibrous band that runs along the tips of the spinous processes from the seventh cervical vertebra (C7) to the sacrum. Superiorly, it continues as the ligamentum nuchae, and inferiorly, it blends with the thoracolumbar fascia. It lies posterior to the interspinous ligaments and plays a critical role in maintaining spinal stability.

The ligament is composed of dense longitudinal collagen fibers, firmly attaching to the apices of spinous processes and interconnecting adjacent vertebrae. It is thickest in the thoracic and lumbar regions, where it resists excessive forward flexion of the spine.

Clinically, the supraspinous ligament is important in spinal trauma, degenerative changes, and inflammatory conditions. It is often evaluated in the context of whiplash injuries, ankylosing spondylitis, ligamentous tears, and post-surgical spinal stability.

Synonyms

  • Ligamentum supraspinale

  • Posterior spinous ligament

Function

  • Provides longitudinal support to the vertebral column

  • Restricts excessive flexion of the spine

  • Helps maintain alignment of spinous processes

  • Works synergistically with the interspinous ligament and ligamentum flavum

  • Serves as a stabilizer in thoracolumbar and cervical spine mechanics

MRI Appearance

T1-weighted images:

  • Appears as a low-signal-intensity band connecting the tips of spinous processes

  • Distinct from intermediate-signal paraspinal muscles and fat planes

T2-weighted images:

  • Normal ligament: low signal intensity

  • Tears, degeneration, or edema appear as hyperintense foci within or around ligament

STIR:

  • Suppresses fat, highlighting ligamentous edema, injury, or inflammation as bright hyperintensity

  • Very sensitive for detecting acute ligament injury

T1 Fat-Saturated (Pre-contrast):

  • Ligament remains low signal intensity against suppressed fat background

  • Helps delineate partial disruptions from adjacent fat planes

T1 Fat-Saturated Post-Contrast (Gadolinium):

  • Supraspinous ligament shows intermediate signal intensity, contrasting with suppressed fat

  • Allows better visualization of ligament margins and subtle injury

MRI 3D Reconstructions:

  • Provide multiplanar visualization of ligament integrity and continuity

  • Useful for pre-surgical planning and trauma assessment

CT Appearance

CT Pre-Contrast:

  • Ligament not directly visible as a separate structure

  • Indirectly inferred from the relationship of spinous process alignment and adjacent soft tissue planes

CT Post-Contrast:

  • Enhancement usually limited to adjacent soft tissue if inflammation or infection is present

  • Indirect role in assessing trauma, calcification, or ossification (as in ankylosing spondylitis or DISH)

  • High-resolution CT demonstrates ossified or calcified supraspinous ligament in chronic disease

MRI image

Supraspinous ligament MRI axial anatomy image -img-00000-00000

MRI image

Supraspinous ligament MRI sagittal anatomy image -img-00000-00000

CT image

Supraspinous ligament CT axial image