Evaluation of effective role of posterior longitudinal ligament in management of traumatic spine injuries

Introduction: Ligaments are fi brous bands or sheets of connective tissue linking two or more bones, cartilages or structures together. The ligaments provide stability to a joint during rest and movement. Excessive movements such as hyperextension or hyperfl exion or rotations may be restricted by ligaments. In the spine, the ligament helps to provide structural stability. Materials and Methods: The study of 32 patients, with acute dorsolumbar and cervical fractures, admitted to hospital was carried out. Thorough clinical assessment in the form of mechanism of injury, inspection and palpation of spinous process, and neurological examination was carried out. Patients were investigated in the form of X-ray, computed tomography (CT) scan, magnetic resonance imaging, and CT scan showed a pattern of bony injury. White and Punjabi criteria were used to identify instability in vertebral column and treated (conservatively/operatively) accordingly. Fractures are classifi ed by McAfee and modifi ed Magerl (AO/Association for the Study of Internal Fixation) classifi cation system. Results: In our experience of spine fractures, very minor cases can be treated with bed rest and physiotherapy; 30% of lesions can be managed with closed treatment; only 60% will require surgery. Distraction posteriorly requires intact anterior longitudinal ligament (ALL) (to prevent over distraction-anatomical hinge) with or without intact posterior longitudinal ligament (PLL) but for indirect reduction of fracture fragments retropulsed into spinal canal by ligamentotaxis intact PLL is required. If PLL is ruptured surgeon considered either anterior or posterior approach to directly decompress spinal canal and fusion rather than relying on posterior distraction and fusion alone. Conclusion: PLL forms important structure stabilizing spine along with ALL and ligamentum fl avum and other ligaments, helps in resisting excess of fl exion, lateral bending, and spinal rotation to lesser extent. It aids in the indirect reduction of fracture fragments by ligamentotaxis.