The anterior longitudinal ligament in the thoracic spine is a broad, strong band running along the anterior vertebral bodies from C2 to the sacrum, firmly adherent to the vertebral body endplates but loosely attached over the disc annulus.
Resists hyperextension of the thoracic spine, maintains vertebral alignment during normal loading, and reinforces the anterior annulus fibrosus of the thoracic intervertebral discs.
DISH (diffuse idiopathic skeletal hyperostosis) produces flowing ossification along the thoracic anterior longitudinal ligament on the right side (spared on the left by the aorta), causing stiffness without disc space loss — distinct from ankylosing spondylitis. Thoracic ALL ossification can produce dysphagia when prominent in the lower cervical or upper thoracic region.
Flowing right-sided thoracic ALL calcification in diffuse idiopathic skeletal hyperostosis producing spinal stiffness without inflammatory markers, managed conservatively.
Anterior longitudinal ligament tear in thoracic flexion-distraction injury producing anterior column disruption, contributing to thoracic instability.
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