The thoracic interspinous ligaments fill the space between adjacent thoracic spinous processes, blending with the supraspinous ligament posteriorly and the ligamentum flavum anteriorly.
Resist thoracic flexion by limiting separation of the spinous processes, form part of the posterior tension band that prevents anterior column failure in compression injuries, and are assessed in thoracic instability evaluation.
Widening of thoracic interspinous spaces on plain X-ray (spinous process fanning) indicates disruption of the interspinous ligament and posterior tension band, confirming unstable fracture pattern requiring posterior fixation.
Spinous process fanning on lateral X-ray from interspinous ligament rupture in Chance fracture equivalent, requiring posterior instrumented fusion.
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