Objective: To explore the application value of coronal T2-weighted Dixon imaging based on magnetic resonance imaging in the classification of interspinous ligament degeneration in patients with low back pain. Methods: The imaging and clinical data of 60 patients with low back pain who underwent lumbar MRI examination from January 2022 to August 2023 were prospectively collected. According to the fat and water images of coronal T2-weighted Dixon sequence, the study group divided the whole interspinous ligament into type A, type B, type C, type D and mixed type. The mixed type included B-C, D-B, D-B-C and D-C. In the control group, the middle part of the interspinous ligament was divided into type A, type B, type C and type D by sagittal T1WI/T2WI sequence. The difference of degeneration types of interspinous ligament between the two groups was compared. Results: The consistency of the results of the two classification methods was as follows: the kappa coefficient of the study group: intra-observer [0.852-0.916] and inter-observer [0.747-0.753]), and the kappa coefficient of the control group: intra-observer [0.801-0.823] and inter-observer [0.689-0.703]). The incidence of type C in the study group was 54.1%, which was significantly higher than that in the control group (P<0.05). The incidence of new mixed type in the study group was 46.7%, among which B-C and D-C types were the most common. Conclusion: The classification method of interspinous ligament degeneration based on coronal T2-weighted Dixon magnetic resonance imaging is reliable and repeatable, which can improve the identification rate of interspinous ligament and the detection rate of type C, and can further distinguish the mixed type and subtype.