The cervical portion of the posterior longitudinal ligament runs behind the vertebral bodies and discs within the spinal canal. It is broader in the cervical region than lower down, firmly attached at the disc levels and expanded laterally at the disc interspaces, narrowing over the vertebral bodies. Above, it continues as the tectorial membrane.
| Origin | Posterior body of the axis, continuous above with the tectorial membrane |
|---|---|
| Insertion | Posterior surfaces of the cervical vertebral bodies and discs, continuing into the thoracic spine |
Resists flexion and posterior disc herniation into the canal, the lateral lacunae represent zones of weakness where posterolateral disc herniation most commonly occurs.
OPLL (ossification of the posterior longitudinal ligament) is a common cause of cervical myelopathy in East Asian populations, progressively narrowing the canal. Anterior corpectomy and fusion suit focal disease, while posterior laminoplasty or laminectomy and fusion suit multilevel OPLL. In anterior cervical discectomy, the PLL may be opened or removed when disc fragments lie behind it or when full cord decompression is needed. The hourglass shape of the normal PLL produces lateral weak zones through which disc herniations migrate posterolaterally.
Posterior longitudinal ligament ossification progressively narrowing the cervical spinal canal producing upper motor neuron signs, managed by anterior decompression or posterior laminoplasty.
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