The cervical portion of the anterior longitudinal ligament, running along the anterior vertebral bodies from the occiput to the sacrum, firmly adherent to the disc annuli and loosely to the vertebral bodies.
| Origin | Basilar part of the occipital bone and anterior tubercle of the atlas |
|---|---|
| Insertion | Anterior surfaces of the cervical vertebral bodies and discs, continuing into the thoracic spine |
Resists extension and anterior vertebral body separation, the primary restraint to cervical hyperextension.
The anterior longitudinal ligament is disrupted in hyperextension injuries, especially in older patients with spondylosis, where an ALL and disc tear without fracture can cause acute central cord syndrome, and in the ankylosed spine where extension injuries are highly unstable. Prevertebral soft tissue swelling on radiographs may be the only sign. DISH (diffuse idiopathic skeletal hyperostosis) is flowing ossification along the ALL, and large anterior cervical osteophytes can cause dysphagia that may need resection. In anterior cervical discectomy the ALL is incised over the operated disc level.
Anterior longitudinal ligament tear in hyperextension producing anterior annular disruption and prevertebral haematoma, sometimes with central cord syndrome, managed with a collar or surgery for instability.
Bulky ossification along the cervical ALL compressing the oesophagus, treated by osteophyte resection when symptomatic.
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