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.
Resists extension and anterior vertebral body separation — the primary restraint to cervical hyperextension.
The anterior longitudinal ligament is disrupted in hyperextension injuries — DISH (diffuse idiopathic skeletal hyperostosis) is florid ossification of the ALL producing a flowing anterior osteophyte. In anterior cervical discectomy, the ALL is preserved unless corpectomy is performed.
Anterior longitudinal ligament tear in whiplash-type hyperextension producing anterior annular disruption and retropharyngeal haematoma, managed conservatively with collar or surgically for instability.
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