[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Spine](https://durgical.com/en/anatomy/region/spine/) › Nuchal ligament [Joints and ligaments](https://durgical.com/en/anatomy/system/joints-and-ligaments/) · [Spine](https://durgical.com/en/anatomy/region/spine/) # Nuchal ligament The nuchal ligament is a thin midline sheet at the back of the neck, from the skull to C7; it helps hold the head up and anchors neck muscles. [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=spine&select=nuchal_lig&side=r) Opens in the Durgical app, no sign-up needed. ## What it is A thin midline sheet at the back of the neck, from the skull to C7: the upward continuation of the [supraspinous ligament](https://durgical.com/en/anatomy/supraspinous-ligament/). ## What it does Helps hold the head up and anchors neck muscles such as the trapezius and splenius. ## Key points - In humans it is a thin fibrous midline septum; in grazing animals it is a thick elastic cable that holds the head up - It divides the back of the neck into right and left muscle halves: a relatively bloodless plane for the midline posterior approach - It makes the C3–C5 spinous processes hard to feel; C2 and C7 (often C6 too) are the ones usually felt ## Key facts **Attaches** External occipital protuberance and crest to posterior tubercle of atlas and spinous processes C2–C7 **Function** Midline septum for muscle attachment (trapezius, splenius capitis, [rhomboid minor](https://durgical.com/en/anatomy/rhomboid-minor/), [serratus posterior](https://durgical.com/en/anatomy/serratus-posterior-superior-muscle/) superior); helps support the head **Tight in** Neck and head flexion ## Relations **Superficial** [Skin](https://durgical.com/en/anatomy/skin/) and fat of the back of the neck, and the [trapezius](https://durgical.com/en/anatomy/trapezius-muscle/) origin on each side **Deep** Posterior tubercle of the [atlas](https://durgical.com/en/anatomy/atlas/), spinous processes of C2–C7 and the [interspinous ligaments](https://durgical.com/en/anatomy/interspinous-ligaments/); at the top, the posterior atlanto-occipital membrane **Lateral** [Splenius](https://durgical.com/en/anatomy/splenius-capitis-muscle/) capitis and [semispinalis](https://durgical.com/en/anatomy/semispinalis-muscles/) capitis; the greater occipital nerve comes out through semispinalis capitis and trapezius a little lateral to its upper end ## How to find it With the chin tucked to the [chest](https://durgical.com/en/anatomy/region/chest/) it tightens and is felt as a midline ridge from the external occipital protuberance down to the prominent C7 spinous process. ## On imaging A lateral cervical radiograph sometimes shows a small calcification (nuchal ossicle) behind the spinous processes, an incidental finding. MRI can show high signal after a flexion or whiplash injury. ## Clinical notes - The midline posterior cervical approach follows this plane, limiting bleeding and muscle damage - Clay-shoveler fracture: avulsion of a lower cervical or upper thoracic spinous process (C7 most often) by the pull of the muscles and ligaments attached to it ## Anatomical variants - Calcified or ossified nodules inside the ligament, usually in the lower neck, are a frequent incidental finding on lateral neck X-rays; they should not be mistaken for a fractured spinous process ## Related conditions - [Whiplash (cervical sprain)](https://durgical.com/en/conditions/whiplash/) ## Test yourself Think of the answer, then tap the question to see it. ## Where does the nuchal ligament attach? From the external occipital protuberance and crest to the posterior tubercle of the atlas and the spinous processes of C2–C7; it continues the supraspinous ligament upward. ## Which muscles attach to the nuchal ligament? The trapezius, splenius capitis, rhomboid minor and serratus posterior superior; it serves as a midline septum for them. ## Why does the midline posterior cervical approach follow the nuchal ligament? It divides the back of the neck into right and left muscle halves, a relatively bloodless plane that limits bleeding and muscle damage. ## What is a clay-shoveler fracture, near the lower end of the nuchal ligament? Avulsion of a lower cervical or upper thoracic spinous process, most often C7, by the pull of the muscles and ligaments attached to it. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/nuchal-ligament/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** ligamentum nuchae TA2 1678 **Official Spanish (DeCS)** Ligamento nucal **English (TA2)** Nuchal ligament **Also called** septum nuchae ## Related - [Supraspinous ligament](https://durgical.com/en/anatomy/supraspinous-ligament/) - [Atlas (C1)](https://durgical.com/en/anatomy/atlas/) - [Axis (C2)](https://durgical.com/en/anatomy/axis/) - [C3 vertebra](https://durgical.com/en/anatomy/cervical-vertebrae/) - [C4 vertebra](https://durgical.com/en/anatomy/c4/) - [C5 vertebra](https://durgical.com/en/anatomy/c5/) - [C6 vertebra](https://durgical.com/en/anatomy/c6/) - [C7 vertebra](https://durgical.com/en/anatomy/vertebra-prominens/) Sources: Terminologia Anatomica (TA2); [Anatomy, Head and Neck: Cervical Vertebrae](https://www.ncbi.nlm.nih.gov/books/NBK539734/); [Anatomy, Head and Neck, Suboccipital Muscles](https://www.ncbi.nlm.nih.gov/books/NBK567762/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/nuchal-ligament/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/nuchal-ligament/