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The Impact of Spine Pathology on Posterior Ligamentous Complex Structure and Function

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Abstract

Purpose of Review

Spinal ligament is an important component of the spinal column in mitigating biomechanical stress. Particularly the posterior ligamentous complex, which is composed of the ligamentum flavum, interspinous, and supraspinous ligaments. However, research characterizing the biomechanics and role of ligament health in spinal pathology and clinical context are scarce. This article provides a comprehensive review of the implications of spinal pathology on the structure, function, and biomechanical properties of the posterior ligamentous complex.

Recent Findings

Current research characterizing biomechanical properties of the posterior ligamentous complex is primarily composed of cadaveric studies and finite element modeling, and more recently incorporating patient-specific anatomy into finite element models. The ultimate goal of current research is to understand the relative contributions of these ligamentous structures in healthy and pathological spine, and whether preserving ligaments may play an important role in spinal surgical techniques.

Summary

At baseline, posterior ligamentous complex structures account for 30–40% of spinal stability, which is highly dependent on the intrinsic biomechanical properties of each ligament. Biomechanics vary widely with pathology and following rigid surgical fixation techniques and are generally maladaptive. Often secondary to morphological changes in the setting of spinal pathology, but morphological changes in ligament may also serve as a primary pathology. Biomechanical maladaptations of the spinal ligament adversely influence overall spinal column integrity and ultimately predispose to increased risk for surgical failure and poor clinical outcomes. Future research is needed, particularly in living subjects, to better characterize adaptations in ligaments that can provide targets for improved treatment of spinal pathology.

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Funding

This research received funding from the Scripps Clinical Medical Group Research Award #2021–0223. No other funding was received from agencies in the public, commercial, or not-for-profit sectors.

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  1. Department of Orthopaedic Surgery, The University of California San Diego, 9500 Gilman Dr., MC0863, La Jolla, San Diego, CA, 92093, USA

    Bradley Anderson & Bahar Shahidi

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Correspondence to Bahar Shahidi.

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Anderson, B., Shahidi, B. The Impact of Spine Pathology on Posterior Ligamentous Complex Structure and Function. Curr Rev Musculoskelet Med 16, 616–626 (2023). https://doi.org/10.1007/s12178-023-09873-9

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