A Case-Based Review of Spine Ligamentous Anatomy and Pathology

Back pain is a common symptom, with a variety of acute and chronic causes. Spinal ligaments play an important role in spinal stability and mechanics and may be subject to a variety of pathologic conditions presenting as acute or chronic back pain. These structures include the craniocervical ligaments (tectorial membrane, transverse ligament, and alar ligaments) and cervical, thoracic, and lumbar ligaments (anterior longitudinal, posterior longitudinal, interspinous, and supraspinous ligaments and ligamentum flavum). Each of these structures is susceptible to acute injury or chronic pathology, such as inflammatory spondyloarthropathies. MRI plays an important role in the workup of both acute spinal injury and chronic changes. Ligamentous pathology may be overlooked without specific attention to and familiarity with normal appearance of these structures. In this article, the radiologist will gain familiarity with normal and abnormal MRI appearance of spinal ligaments.