The anterior longitudinal ligament is a broad, strong band running down the anterior vertebral column from the atlas to the sacrum, firmly adherent to the vertebral bodies but loosely attached over the intervertebral discs. It is the primary restraint to spinal hyperextension and is the ligament most commonly disrupted in extension injuries of the cervical spine, including whiplash and fracture-dislocation.
| Origin | Anterior tubercle of the atlas (C1) |
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| Insertion | Continuous along the anterior surfaces of all vertebral bodies to the sacrum |
| Actions | Resists spinal extension and anterior vertebral body separation; the strongest ligament of the spine per unit area |
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ALL rupture is a defining feature of extension type cervical injuries including the hyperextension distraction injury that produces central cord syndrome, the most common incomplete spinal cord injury pattern in older adults. It is also involved in the spondylotic process where it ossifies anteriorly with age, producing osteophytes that can cause dysphagia when large enough to compress the oesophagus.
Disruption from hyperextension injury producing spinal instability associated with central cord syndrome in elderly spondylotic spines, managed with cervical collar or surgical fusion depending on neurological status and instability.
