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Ligaments of the vertebral column in the cervical spine

This is an excerpt from Spinal Manipulations and Mobilization Techniques by John Gibbons.

In the list below are some of the ligaments of the vertebral column; some are mentioned in chapter 2 because they relate in particular to the lumbar spine and pelvis. Figure 1.5 shows the cervical spine ligaments.

• Posterior and anterior longitudinal ligaments
• Ligamentum flavum
• Interspinous ligament
• Supraspinous ligament
• Ligamentum nuchae
• Alar ligament
• Transverse ligament of atlas
• Cruciform ligament

Posterior and Anterior Longitudinal Ligaments

These two ligaments—as the name suggests—are long ligaments that attach to the vertebral bodies from the cervical spine all the way down to the sacrum. They limit the amount of flexion (posterior longitudinal ligament) and extension motion (anterior longitudinal ligament) of the vertebral column, as well as assisting the stability of the intervertebral discs.

Ligamentum Flavum

The ligamentum flavum is very different to the longitudinal ligaments because it is both very short and thick—especially in the lumbar spine—and connects the laminae of adjacent vertebrae, from C2 all the way down to S1. This unique ligament is very interesting because it contains approximately 80% elastin fibers, which provide the flexible motion and give the ligament its yellow appearance. The remaining 20% is collagen. Because of the increased number of elastic fibers, this ligament provides a kind of recoil to maintain the column’s shape after flexion. Ligamentum flavum also prevents the capsules of the facet joints being pinched during spinal movements.

Interspinous Ligament

As the word suggests, these ligaments connect the spinous processes of adjacent vertebrae—one segment at a time—from C1 all the way down to S1. Their role is to limit flexion of the spinal column by restricting the separation motion of the spinous processes.

Supraspinous Ligament

This strong fibrous connection links the spinous processes of vertebrae from C7 to the sacral spine. The supraspinous ligament becomes progressively wider as it travels from the thoracic to the lumbar spine and also merges with a fascial structure called the thoracolumbar fascia. Its main role is to limit flexion of the spinal column and provide an attachment for certain muscles.

Ligamentum Nuchae

Also known as the nuchal ligament, this is continuous with the supraspinous ligament and attaches to the occipital protuberance (so-called “bump of knowledge”) located at the base of the occipital bone (spinous process of C2) and the nuchal line and connects with the spinous process of C7. There is also a small attachment directly to the posterior tubercle (no spinous process present here) of the atlas (C1) vertebra.

This ligament will limit flexion of the cervical spine and allows the attachment of two important muscles, the trapezius and splenius capitis.

Alar Ligaments

These are two rounded structures that stabilize the level of C1 and C2, especially for rotation, and become taut in cervical flexion. They attach from either side of the odontoid process to the occipital condyles.

Transverse Ligament of Atlas

This small but very thick, strong ligament stabilizes the odontoid process. Interestingly, the anterior part of this ligament is covered with articular cartilage because of the articulation it serves with the odontoid process for rotation of the cervical spine. The attachment of this ligament separates the atlas (C1) ring into two distinct parts of unequal size. The smaller space allows for the odontoid process, and the larger space accommodates the spinal cord and its membranes.

Cruciform Ligament

As the name suggests, this ligament is similar in shape to a cross, and is also commonly called the cruciate ligament of the atlas. It serves to stabilize the atlanto-axial joint (AAJ) joint (C1/C2) by maintaining the posterior part of the dens (odontoid process) of C2 in place within the AAJ.

The cruciform ligament has two individual bands: the longitudinal band, which has a superior and inferior part, and the transverse ligament of atlas (explained above). Together they form this unique structure.

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