The anterior longitudinal ligament in the lumbar spine is broad and thickest at this level, firmly attached to the vertebral body endplates but loosely attached over the disc annulus. It is the primary restraint against lumbar extension.
Resists hyperextension of the lumbar spine, reinforces the anterior disc annulus, maintains vertebral alignment during extension loading, and is the structure that ossifies in ankylosing spondylitis to produce bamboo spine.
The lumbar ALL is divided in ALIF (anterior lumbar interbody fusion) surgery to access the disc space, and in ALL release for lumbar lordosis restoration in adult spinal deformity correction. DISH produces anterior ALL ossification without sacroiliac involvement, distinguishing it from ankylosing spondylitis.
Bamboo spine from anterior longitudinal ligament ossification in AS producing complete anterior spinal fusion, with fractures through the fused column causing highly unstable three-column injuries.
Anterior longitudinal ligament sectioning in ALIF or via LLIF approach allows disc space distraction and segmental lordosis restoration in adult degenerative flat-back deformity.
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