Spinous process fractures are a relatively rare but significant complication associated with lumbar ligament reconstruction. They often result from excessive mechanical stress during artificial ligament placement, ligament tension imbalance, or patient-related factors such as osteoporosis. These fractures can cause postoperative localized pain, reduced mobility, and mechanical instability, potentially delaying recovery or necessitating revision surgery. Key risk factors include over-distraction during ligament placement, over-resection during decompression, and inadequate preoperative bone health optimization. Symptoms typically present as focal tenderness, mechanical back pain, and restricted range of motion, with imaging techniques such as CT and MRI playing a critical role in diagnosis. Effective prevention strategies emphasize meticulous surgical techniques, including preserving spinous process integrity, gentle ligament handling, and balanced ligament tensioning. Preoperative optimization of bone density through medications such as bisphosphonates or teriparatide is particularly crucial for osteoporotic patients. Postoperative care should include gradual rehabilitation and activity modifications to minimize stress on the spinous processes. Management of fractures varies depending on severity and symptoms, ranging from conservative measures such as pain control, bracing, and restricted activity to surgical interventions like extension of ligament reconstruction. Future advancements in surgical techniques and patient-specific care are essential to further reduce the risk of spinous process fractures and improve clinical outcomes.