Cervical Spine Tension Band Anatomy
Anterior Tension Band
The anterior tension band of the cervical spine consists of the anterior longitudinal ligament, intervertebral disc, and the anterior portion of the vertebral body. These structures resist distraction forces during extension movements 1.
- The anterior longitudinal ligament runs along the anterior surface of the vertebral bodies and limits extension of the spine 2
- The intervertebral disc (annulus fibrosus) is one of the largest and most rigid stabilizing structures of the cervical spine 2
- The anterior vertebral body itself contributes to the anterior column integrity 1
When the anterior tension band fails, as in distraction-extension injuries, anterior reconstruction with plating acts as a tension band to restore stability 1.
Posterior Tension Band
The posterior tension band comprises the posterior ligamentous complex, including the ligamentum flavum, interspinous ligament, supraspinous ligament, facet joint capsules, and the posterior bony elements (spinous processes and laminae). This complex resists distraction during flexion 3, 4.
Key Posterior Structures:
- Ligamentum flavum: An elastic ligament that permits extension without impinging on neural structures 2
- Interspinous and supraspinous ligaments: Limit spinal flexion 2
- Facet joint capsular ligaments: Among the largest and most rigid cervical ligaments, providing primary stabilization 2
- Posterior bony arch: Spinous processes and laminae provide structural support 3
Clinical Significance
Complete disruption of the posterior tension band (as in distractive-flexion stage 3 injuries) creates highly unstable injuries that cannot be adequately stabilized with anterior fixation alone 4.
- Anterior plating alone in DF-3 injuries fails to restore stability and allows considerable motion in all planes 4
- Reconstruction of the posterior tension band is essential in unstable injuries, achievable through posterior wiring, transarticular facet screws, or pedicle screw-rod constructs 3, 4
- Combined anterior-posterior stabilization provides optimal stability when both tension bands are disrupted 3, 4
Surgical Implications:
- Posterior tension band wiring achieves 96% fusion rates and allows early mobilization with collar support alone 5
- In distraction-extension injuries where the anterior tension band fails, anterior plating functions as a tension band replacement 1
- Avoid over-distraction during anterior graft placement, as this has caused neurologic deterioration in multiple cases 1