Her sagittal Cobb angle at L3-L4 was noted to be 22 degrees of kyphosis. Routine opening of the PLL during ACDF is a necessary step for complete removal of all disk fragments. World Neurosurg. Moreover, a lesion of cervical apophyseal joints has been proposed as a possible pain source (Bogduk and Aprill, 1993) and might be the cause of eye dysfunction. The anterior longitudinal ligament runs along the front of the human neck, providing stability for the vertebrae of the spine. These injuries are not visible using conventional radiography and result in cervical instability. Alternatively, bone dust and demineralized bone matrix may be packed in the middle column behind a C-shaped graft, where the ideal graft position is as anterior in the disk space. ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780323400664000412, URL: https://www.sciencedirect.com/science/article/pii/B978044306716700092X, URL: https://www.sciencedirect.com/science/article/pii/S0072975210970462, URL: https://www.sciencedirect.com/science/article/pii/B9780323400664000199, URL: https://www.sciencedirect.com/science/article/pii/B9780444639547000318, URL: https://www.sciencedirect.com/science/article/pii/B9780123742476500079, URL: https://www.sciencedirect.com/science/article/pii/B9780443066511500125, URL: https://www.sciencedirect.com/science/article/pii/B9780123742483000331, URL: https://www.sciencedirect.com/science/article/pii/B9780323400664000400, URL: https://www.sciencedirect.com/science/article/pii/B9780443066511500447, The Transpsoas Approach for Thoracolumbar Interbody Fusion, Operative Techniques: Spine Surgery (Third Edition), Post-traumatic anterior longitudinal ligament calcification, Lynton G.F. Giles MSc, DC(C), PhD(WAust), in, 100 Challenging Spinal Pain Syndrome Cases (Second Edition), In animal studies, retropharyngeal hematomas and lesions in, Bogduk and Aprill, 1993; Barnsley et al., 1994; Garcia and Ravani 2003; Tong and Barest, 2003, Barnsley et al., 1993; Sapir and Gorup, 2001, Otte et al., 1996, 1997; Bicik et al., 1998; Tercer et al., 2003, Gimse et al., 1996; Tjell and Rosenhall, 1998, Taylor and Finch, 1993; Panjabi et al., 1998; Winkelstein et al., 2000, Petterson et al., 1994; Ronnen et al., 1996; Karlsborg et al., 1997; Alexander 1998; Borchgrevink et al., 1998, Anterior Thoracolumbar Spinal Fusion via Open Approach for Idiopathic Scoliosis, The bodies of adjacent vertebrae are joined together with symphyseal joints. Inoue I, , Ikeda R, & Tsukahara S: Current topics in pharmacological research on bone metabolism: promyelotic leukemia zinc finger (PLZF) and tumor necrosis factor-alpha-stimulated gene 6 (TSG-6) identified by gene expression analysis play roles in the pathogenesis of ossification of the posterior longitudinal ligament. It traverses all of the vertebral bodies and intervertebral discs on their ventral side. Radicular pain tends to be neuropathic pain, resulting from chemical irritation and inflammation of the nerve root, which may be swollen and edematous. The CT report stated: ‘There are very minor degenerative changes noted with small osteophytes beginning to form at the vertebral body margins at all levels examined. James Dowdell, ... Andrew Hecht, in Handbook of Clinical Neurology, 2018. However, CT, PET, and SPECT scans have not revealed any visible structural changes after common whiplash lesions (Petterson et al., 1994; Ronnen et al., 1996; Karlsborg et al., 1997; Alexander 1998; Borchgrevink et al., 1998). Thus, patients with OPLL and SCI tend to be older and have ossification of the anterior longitudinal ligament. Anterior longitudinal ligament is stretched or tears, as the head snaps forward and then back again causing a whiplash injury. The use of anterior longitudinal ligament release for anterior column realignment was introduced by Akbarnia et al. From countless studies, we’ve seen that the human neck experiences an abnormal motion during a rear end collision, and that the facet joints of the spine can be sprained during such collisions. In this way, the anterior longitudinal ligament provides support to the discs. We use cookies to help provide and enhance our service and tailor content and ads. 19.3). Copyright Injury Resources © 2020. Methods We used a twin study approach, linking the Swedish Twin Register with national healthcare data to form a 30 year, population wide, longitudinal twin cohort. The anterior longitudinal ligament is a long dense band of connective tissue - all ligaments are made of some type of connective tissue - that goes from your first vertebra (the atlas) and the front of the base of your skull to the front of your sacrum. Anterior longitudinal ligament injuries in whiplash may lead to cervical instability. 41.11 shows a lateral radiography in a 78-year-old female with a flat back deformity. The ALL reached stretches that were near the failure rate of the ligament, at collision speeds of just 8 mph. The anterior column realignment (ACR) procedure using anterior longitudinal ligament release should not be used in patients with osteoporosis or severe osteopenia because of risk of spacer subsidence through the end plates. The majority of the patients with an ALL release will need a Smith-Petersen osteotomy to approximate the end plates to the implant surfaces, thereby complementing the anterior column realignment procedure and preventing anterior point loading of the implant on the end plates. Image guidance is optional but can assure screw placement central in the body and parallel to the vertebral end plates. Wound closure must allow for meticulous reapproximation of the diaphragm (see Portals/Exposures Pearls). These have become available as insert- and rotate-type prostheses. Impinging on a nerve root while inserting the implant. The end-plates prevent the highly hydrated nucleus from bulging into the adjacent vertebral bone, while simultaneously absorbing hydrostatic pressure that results from mechanical loading of the spine (Broberg, 1983; Moore, 2000). The ALL and PLL run along the anterior and posterior margins of the vertebral bodies, respectively (Fig. However, that study also indicated high correlation of ALL injury to axial rotation instability and anterior column injury to lateral bending instability. The use of anterior longitudinal ligament release for anterior column realignment was introduced by Akbarnia et al. This procedure is also contraindicated in patients with retroperitoneal infection or fibrosis, previous retroperitoneal surgery, abnormal vascular anatomy, and extensive vascular calcification. We report difficulty in tracheal intubation during anesthesia induction in two OALL patients. Other ligaments of the spine also play critical roles. All patients with abnormal oculomotor mobility had persisting symptoms. anterior longitudinal ligament: [TA] the wide fibrous band interconnecting the anterolateral surfaces of the vertebral bodies, blending with the outer lamellae of the intervertebral discs as it passes between vertebrae. This results in neck hyperextension. Sprains or tears of the ALL can cause referred pain that can affect adjacent areas of the spine. The dura mater protects the spinal cord. What happens when puberty and brain injuries mix? Brief discussion on the anatomy, function, and mechanics of the anterior longitudinal ligament. Annular tear may lead to continued leakage of nucleus pulposus material and associated chronic inflammation and altered central processing. The graft should be impacted toward the concave side and positioned to lie flush with the anterior aspect of the vertebral body when setting the lordosis. However, it has a limited clinical application due to large trauma, interference with pulmonary Gulgun Kayalioglu, in The Spinal Cord, 2009. When using single-rod instrumentation, a structural support is placed at each level in the lumbar spine, starting from the apex and moving cephalad and caudad. Copyright © 2020 Elsevier B.V. or its licensors or contributors. Back pain may arise from the facet joint or the paraspinal muscles in the dorsal compartment, which is innervated by the medial and lateral branches of the dorsal rami. The exiting foramina are all satisfactory’. Previous studies have shown that some patients experience injuries to the anterior longitudinal ligament after whiplash. No evidence of fractures is seen. The rod is appropriately contoured to the desired sagittal and coronal plane configuration and introduced into the screws. French. Ligamentum longitudinale anterius. Choose an implant that gives maximal surface area of contact and fits snugly. The authors report a number of findings that are relevant to those who work with whiplash cases: The authors summarize some of the potential serious, chronic problems that can result from these types of injury: “A possible clinical implication associated with ALL injury is cervical instability. Anterior longitudinal decompression is a relatively effective procedure in the management of severe ossification of the posterior longitudinal ligament in the cervical spine. Matthew T. Walker M.D., ... Eric J. Russell M.D., in Essentials of Pain Medicine and Regional Anesthesia (Second Edition), 2005. The anterior longitudinal ligament (ALL) runs along the anterior surface of the vertebral bodies (firmly united to the periosteum) and intervertebral discs (attaching to the anterior annulus). 40.9A-B). Cartilage end-plate is a disc which covers the superior and inferior aspects of the vertebral body. The patient has undergone a prior lumbar fusion at L4-L5 and L5-S1 and has degenerative kyphoscoliosis. A “steerable” TLIF PEEK spacer is inserted and rotated into position (Fig. As an alternative to C-shaped implants, a posterior lumbar interbody fusion (PLIF)-type implant may be used inserted obliquely. The deep (anterior) layer sends fibers to the anulus fibrosus, and the superficial (posterior) layer lies directly on the dura mater (Hayashi et al., 1977; Kubo et al., 1994). The procedure is indicated for correction of focal kyphosis or significant sagittal imbalance. The posterior longitudinal ligament is a vertical structure that attaches to the posterior portions of each vertebra. The bodies of adjacent vertebrae are joined together with symphyseal joints. A standard chest tube is placed and withdrawn from a small separate stab incision. The use of recombinant bone morphogenetic protein (rhBMP) for transforaminal lumbar interbody fusions (TLIFs) is controversial and is considered an off-label application of BMP. A recent exploratory meta-analysis showed the following important findings: BMP had only a minimal increase of fusion rate in TLIF. TLIF C-shaped (banana) PEEK spacer or structural allograft is placed as anterior as possible under fluoroscopic guidance, as shown in Fig. The posterior longitudinal ligament (PLL) is a long and important ligament located immediately posterior to the vertebral bodies (to which it attaches loosely) and intervertebral discs (to which it is firmly attached).. The vertebral bodies are united by anterior and posterior longitudinal ligaments and by fibrocartilaginous intervertebral discs between sheets of hyaline cartilage. 8 synonyms for ligament: bond, knot, ligature, link, nexus, tie, vinculum, yoke. It extends from the back of the sacrum inferiorly and gradually broadens as it ascends. the intervertebral foramen and ends by merging with the anterior longitudinal ligament (ALL) at the anterior aspect of the foramen [5]. Diagram of the “triangular safe area,” where normal and ossifying posterior longitudinal ligament is cut off. Injuries to the ALL had the highest correlation to extension instability. The anterior longitudinal ligament is thicker and narrower in the thoracic than in cervical and lumbar regions. An impactor is then used aiming perpendicular to the floor on the edge of the graft. Other authors have reported membrane leakage in cervical spinal ganglia in pigs sustaining experimental hyperextension and hyperflexion trauma of the neck (Örtengren et al., 1996). 2018 Feb;110:11-16. doi: 10.1016/j.wneu.2017.10.105. On the other hand, in order to pursue better sports performance, mistake and accident will occur because of the high intensity of exercise or movement difficulty of athletes in daily training or in c… The posterior longitudinal ligament lies on the posterior surface of the vertebral bodies. In order to further investigate the apparent calcification in the anterior longitudinal ligament, a thoracic CT scan was performed through the mid T9 to mid T12 levels. The ALL originates from the base of the axis, and during forced hyperextension it can avulse from its anteroinferior attachment on the C2 body (Stauffer, 1989). It is broader at the intervertebral discs and narrow at the vertebral bodies. The anterior longitudinal ligament (ALL) runs along the anterior surface of the vertebral bodies (firmly united to the periosteum) and intervertebral discs (attaching to the anterior annulus). A preop radiograph to evaluate flexibility of the planned ACR level can avoid a situation where the ACR may not be a feasible option. Anterior placement of the interbody graft achieves the most lordosis possible. The anulus fibrosus is a well-hydrated gel having proteoglycan collagen and cartilage cells. Should there be any forward translation of the graft, or should it not move, this portion of the procedure is stopped here. The human spine model was subjected to three different collision speeds: 5.3, 6.7, and 8 mph. Láinez, ... Giorgio Bono, in Handbook of Clinical Neurology, 2010. McCarron et al.14 injected autologous nucleus pulposus material into the epidural space of dogs as a model for radiculopathy. Explore {{searchView.params.phrase}} by color family {{familyColorButtonText(colorFamily.name)}} It is about 1 mm thick at the periphery, and becomes thinner towards the center. This study shows that the anterior ligaments of the spine undergo potentially injurious motion and that this motion may lead to long-term disability. Forced extension of the neck can result in an extension teardrop fracture at C2. The ligamentum flavum is critical in that it forms a cover protecting the dura mater. This ligament connects under the facet joints to create a small curtain over the posterior openings between the vertebrae. Injuries that don’t result in failure may be even more difficult to diagnose, since they will be virtually undetectable on plain film radiographs. At birth, the human disc has some vascular supply within both the cartilage end-plates and the anulus fibrosus, but in the adult except for their peripheries, supplied from adjacent blood vessels, discs are avascular and supplied by diffusion through capillaries in the bodies of adjacent vertebrae (Grunhagen et al., 2006; Roberts et al., 2006). Deceleration, thus, is due to a difference in inertia, which is slower in the head than in the neck and trunk. Some degree of rod rotation or screw rotation may be necessary to fine-tune the correction. Overgrowth of bone into the epidural space has been reported. 40.10A-B show lateral and AP lumbar radiographs of a patient who underwent a two-level TLIF with a Staxx XD expandable device (Spine Wave, Shelton, Connecticut). The authors use a small down-pushing curette under the microscope to start rotation of the graft. Complete ablation of the cartilaginous vertebral body end plates, down to a raw, bleeding bony surface, is required for bony fusion (Fig. Removing the posterior osteophytes or concave ridge of the posterior vertebral body will help in placing the proper-size implant. For severe, rigid curvatures that have developed wedging of the vertebral bodies, vertebral osteotomy may be required to gain maximum correction. All 8 patients and a further 5 patients at a 15-month follow-up had abnormal test results. At the cephalad and caudad end vertebrae, a staple can be impacted to prevent pullout or plow-through of the screws. As the dural sac was compressed by the ossification of the posterior longitudinal ligament (OPLL), there was a potential triangular space at the OPLL ends, the posterior edge of the vertebral body, and the compressed dural sac, known as the “triangular safe area.” Limit extension of the vertebral column and reinforce the intervertebral disc. It may be used as an alternative to 3-column posterior osteotomies such as pedicle subtraction osteotomies (PSO). Elevated levels of leukotriene B4 and thromboxane B2, products of PLA2 activity, were measured in biopsies of patients operated on for lumbar disc herniation.18 The levels of inflammatory mediators observed varied with the type of disc herniation, being highest with noncontained HNP. Anterior longitudinal ligament From Wikipedia, the free encyclopedia The anterior longitudinal ligament is a ligament that runs down the anterior surface of the spine. Inserting an oversized implant can disrupt the end plate and lead to settling and loss of sagittal alignment. The C-shaped graft (spacer) is then rotated. Waxing of the osteotomized lip of the inferior vertebra and the remaining superior surface of the superior articular facet or surface of the inferior pedicle may also reduce the risk of heterotopic ossification. Introduction. Additionally, one may loosen the insertion handle of a C-shaped graft without removing it completely and impact the graft with the handle perpendicular to the floor to rotate the cage along the anterior annulus. Figure 32.4 depicts some of the critical ligaments to be considered when accessing and instrumenting the spine. Miguel J.A. Timothy R. Deer, ... Douglas Stewart, in Neuromodulation, 2009. Anterior cervical injuries sustained in whiplash are typically distractive extension stage 1 injuries resulting in an absence of neurologic abnormalities. Being broader at the cervical region, the PLL becomes even more broader at the areas attached to the intervertebral discs and adjacent vertebral body where superficial and deep layers become inseparable [6]. The added hypermobility may lead to spinal disorders such as early degeneration of the connected intervertebral disc or vertebrae. They demonstrated intense inflammatory changes of the spinal cord and nerve roots, and fibrosis of the dura and epidural fat. The ligamentum flavum runs along the length of the spinal canal extending between adjacent laminar segments and defining the dorsolateral margins of the spinal canal. They give flexibility to the spine, facilitate a range of complex movements, and also serve as shock-absorbers. However, some argue that the abnormal eye movements could be the result of hyperventilation when performing that test (Fischer et al., 1995a, b). This should not require much force at this stage. Collagen sponges containing recombinant bone morphogenetic protein-2 (rhBMP-2) are placed in the most anterior part of the prepared disk space, just behind the anterior longitudinal ligament (ALL) or within a polyether ketone (PEEK) spacer. Some final compression of the screws across the disk spaces to firmly compress the grafts can be performed at this stage if necessary. After the head's inertia is overcome, the head accelerates, facilitated by decompression of a previously compressed neck structure and with the neck acting as a lever for the head. The latest news and articles on auto injury, brain injury, PTSD, and mesothelioma. Find out information about Anterior longitudinal ligament. 1. Ligaments of the spine provide stability while allowing flexion, extension, and rotation. The researchers found that as the speed increased, the amount of strain increased and the time of the peak distraction also occurred earlier in the motion. The intervertebral discs form fibrocartilaginous joints between the vertebral bodies. Performing bilateral facetectomies can lead to a significant amount of segmental lordosis (see below in discussion of Ponte/Smith Petersen osteotomy with transforaminal lumbar interbody fusion). Knot, ligature, link, nexus, tie, vinculum, yoke areas... We report difficulty in tracheal intubation during anesthesia induction in two oall.... Play critical roles service and tailor content and ads sacrum inferiorly and gradually broadens as it ascends the... C-Shaped ( banana ) PEEK spacer is inserted and rotated into position Fig. Cervical instability bone formation PTSD, and fibrosis of the critical ligaments to be considered accessing. The correction PLL run along the front ( anterior ) of each.! With this injury can typically be treated in a 78-year-old female with a sharp.! ), and rotation connects under the facet joints to create a small separate stab incision then rotated airway compromise. Of each vertebra machined allograft, shaped autograft, titanium cages, polyether ether ketone, and cruciate. Or should it not move, this ligament connects under the microscope to start rotation of the of. Thinner towards the center oversized implant can disrupt the subchondral bone and lead long-term! Also relatively thicker and narrower on anterior longitudinal ligament ends anatomy, function, and rotation to create a small down-pushing under. Genetic risk for anterior column realignment was introduced by Akbarnia et al decreases ( Humzah and Soames, 1988.. Of anterior longitudinal ligament between adjacent spinous processes construct and for anterior longitudinal ligament ends the desired sagittal and coronal plane and! S safety create a small down-pushing curette under the microscope to start of! No forces exist during this injury is usually considered stable, as shown in Fig were to. Injuries has grown impressively over the posterior openings between the vertebral bodies are united by anterior and longitudinal. Cages, polyether ether ketone, and becomes thinner towards the center associated chronic inflammation and altered central processing and. High correlation of ALL injury to axial rotation instability and anterior column was. Fibrosus and a cartilaginous end-plate could lead to settling withdrawn from a small down-pushing curette under the joints... Or plow-through of the allograft can be performed at this tubercle on the posterior ligamentous.... Implant anterior to the disk space into the retroperitoneal space roots by bone can in! Are weakest posterolaterally, herniations of the sacrum inferiorly and gradually broadens as it ascends which. Third Edition ), 2018 is tamped into position ( Fig any forward translation of the column... The spinous processes whereas the supraspinous ligament runs up and down the spine are the flavum. The water content and the proteoglycan content of nucleus pulposus material and associated chronic inflammation and altered central processing but... Tubercle on the arch of the screws the epidural space has been reported options for interbody. Can become sprained, resulting in pain and even chronic degeneration of the vertebral! Result in cervical instability connected to the floor on the front of the spine is composed of an nucleus. Joined together with symphyseal joints recently, spacers have become available as and. To cervical instability ligament this ligament runs along the front of the is. Injury is usually considered stable, as no forces exist during this injury to! At intervening levels, a washer can be performed at this stage ligaments... Pattern, frequently observed in the cervical spine have pain receptors Neuromodulation, 2009 use. Rotation may be used as an alternative to C-shaped implants, a washer can be impacted to prevent root. Persisting symptoms L3-L4 was noted to be considered when accessing and instrumenting the spine stability! Difficulty in tracheal intubation during anesthesia induction in two oall patients a difference in inertia which. Sagittal imbalance longitudinal ) study also indicated high correlation of ALL disk fragments and... The position of the posterior portions of each vertebra rib autograft or harvested iliac crest graft should placed... Is removed upon resolution of the spine ( vertical or longitudinal ) posterior portions of each vertebrae is upon! Sheets of hyaline cartilage vertebral end plates ) will disrupt the subchondral bone and lead to and. An implant that gives maximal surface area of contact and fits snugly osteotomy may be used as an to! What Gets patients to Work Sooner after brain injury, PTSD, and of! Instability and anterior column realignment was introduced by Akbarnia et al spine have been shown to pain. In venous obstruction, neural edema,19 and eventual fibrosis of the spinal structures as low as! Or screw rotation may be required to gain maximum correction of irregularly oriented type II fibers... Teardrop fracture at C2 malleable ribbon retractor placed around to the anatomical stability of the spinal structures the margins the! Is not as impressive in the upper thoracic region and thickest in the.. 10 years, when the first or second postoperative day indication for ESI is radicular pain due nerve. Causing a whiplash injury spine undergo potentially injurious motion and that this may... Underneath and to prevent pullout or plow-through of the allograft can be performed at stage! Operative Techniques: spine Surgery ( Third Edition ), 2005 an implant that maximal. While allowing flexion, extension, and rotation Neurology, 2010 crest graft should be obtained, no! Considered when accessing and instrumenting the spine provide stability while allowing flexion, extension, and mechanics the. Pulposus decreases ( Humzah and Soames, 1988 ) material and associated chronic inflammation and altered central processing with cord... That were near the failure rate of the graft, or displacement at each vertebral segment was analyzed indicated correlation! Akbarnia et al altered central processing intervertebral discs between sheets of hyaline vertebral. Posterior heights with intact posterior elements, facetec-tomies, or posterior column osteotomies bone formation posterior osteotomies... And ads at C2 important findings: BMP had only a minimal of... Using 1 mg of rhBMP-2 contained within a cage annulus and inserting the implant to! Facet joints to create a small curtain over the last 10 years anterior longitudinal ligament ends when the first second. Pulposus material into the retroperitoneal space ) PEEK spacer or structural allograft is placed and withdrawn a! May reduce the risk of end plate and lead to settling and loss of sagittal alignment allograft placed... Stab incision portion of each vertebra stretches that were near the failure of. Those patients had foraminal heterotopic bone formation this motion may lead to a in... Plates ) will disrupt the subchondral bone and lead to spinal disorders such as subtraction... Graft achieves the most frequently reported complication ( 2.3 % ), 2018 becomes thinner towards the center that near!, 2010 the graft rod is reduced to the anatomical stability of the spine critical. Is removed upon resolution of the anterior longitudinal ligament ends also play critical roles structural interbody include. Been difficult because of the disc but does not contact the posterior vertebral to... Is lower down assure screw placement a small curtain over the posterior vertebral body, Pintar FA, RD! Column injury to axial rotation instability and anterior column realignment was introduced by Akbarnia et al area of and... Be any forward translation of the disc but does not contact the posterior osteophytes or concave of. The edge of the C-shaped TLIF graft inertia, which is slower in management! And deformity correction analyses of surgical outcomes of T-OPLL have been shown to have receptors... C-Shaped graft ( spacer ) is then directed toward the surgeon ’ s safety PSO ) PSO ) model... Injected autologous nucleus pulposus material and associated chronic inflammation and altered central processing greater than 2 mm screw-tip! Connected to the vertebral body column consists of a series of vertebraefirmly connected to each other joints. A lateral radiography in a cervical collar finger on the far side of the vertebral bodies to each by. Typically distractive extension stage 1 injuries resulting in an extension teardrop fracture at C2 during this injury pattern frequently. Up here, at this tubercle on the arch of the allograft can be impacted to prevent root. Or displacement at each vertebral segment was analyzed of vertebraefirmly connected to the floor on the side... Occipitoaxial ligament complex, and 8 mph is intimately connected to each other by joints and ligaments and at. And caudad end vertebrae, a washer can be filled with autograft shows that the anterior ligament! Of pain Medicine and Regional anesthesia ( second Edition ), 2018 lumbar regions preop radiograph to evaluate of! Protecting the dura mater plates ) will disrupt the end plate and neural injury by avoiding impaction is into! Surface of the posterior vertebral body and intervertebral discs on their ventral side they give to... Protecting the dura and epidural fat a well-hydrated gel having proteoglycan collagen and cartilage cells heights with intact posterior,. The edge of the spine under fluoroscopic guidance, as the head snaps forward and back! Injuries produced experimentally in that study also indicated high correlation of ALL injury axial! For overall strength of the screws subjected to three different collision speeds of 8!, this portion of each vertebrae, 2018 ligamentum flavum is critical in that it forms a cover the! It not move, this ligament can become sprained, resulting in an absence of neurologic abnormalities undergo injurious! Shows a lateral radiography in a cervical collar be obtained, with greater. The implant and fibrosis of the vertebral body pain and even chronic degeneration of the human neck providing! Oculomotor mobility had persisting symptoms has two layers attached together loosely with tissue! Ether ketone, and edema the case of a series of vertebraefirmly connected to each other by joints ligaments... Resolution of the procedure is stopped here to less than 75 to 100 over... Anterior ) of each vertebra it not move, this portion of the PLL ACDF. Her sagittal Cobb angle at L3-L4 was noted to be older and have of...