Acute Calcific Tendinitis of the Longus Colli: A Case Report and Review of the Literature.

Acute calcific tendinitis of the longus colli (ACTLC) is a rare, self-resolving condition caused by calcium hydroxyapatite crystal deposition in the longus colli muscle tendons. We present a case of a 46-year-old female with a history of hypertension who presented with right-sided neck pain, worsening abdominal pain, nausea, bloody emesis, and generalized body aches in the context of recent alcohol use. Physical examination revealed neck pain with limited range of motion, induration, and tenderness in the right and posterior neck areas. Laboratory findings showed elevated white cell count, inflammatory markers, and metabolic acidosis with an elevated anion gap and lactic acid level. Computed tomography (CT) of the neck with contrast demonstrated amorphous calcification in the longus colli tendons and retropharyngeal effusion, consistent with the diagnosis of ACTLC. The patient was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and supportive care, leading to symptom resolution. This case highlights the importance of considering ACTLC in the differential diagnosis of acute neck pain and the role of CT imaging in establishing the diagnosis. Prompt recognition and appropriate management of ACTLC can prevent unnecessary interventions and lead to improved patient outcomes.

The Early Effects of Longus Colli Muscle and Anterior Longitudinal Ligament Reconstructions on Swallowing Function after Anterior Cervical Surgery: A Six-Month Follow-Up Study.

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is the gold standard surgery used to treat cervical degenerative disease. Dysphagia and hoarseness are the two most common complications that occur after anterior cervical surgery (ACS). In this study, we aim to evaluate the early effects of longus colli muscle (LCM) and anterior longitudinal ligament (ALL) reconstructions on swallowing function after ACS. METHODS: We recruited 91 patients (35 males and 56 females; mean age: 49.41 ± 8.60 years [range: 26-72 years]) who have undergone either ACDF or anterior cervical corpectomy and fusion (ACCF) between August 2019 and October 2021. Patients were divided into LCM and ALL suture group (Group A), and LCM and ALL non-suture group (Group B). Assessments of the incidence of dysphagia and the swallowing quality of life (SWAL-QOL) were completed in 2 days, 1 week, 1 month, 3 months and 6 months after surgery. Average prevertebral soft tissue thickness (APSTT) were measured on lateral cervical spine radiographs taken with X-rays 2 days, 1 month, 3 months and 6 months after surgery. RESULTS: In the 2-day, 1-week and 1-month postoperative follow-up, the incidence of dysphagia in group A was significantly lower than that in group B (p < 0.05), and the SWAL-QOL scores of group A were significantly higher than those of group B (p < 0.05). In the 3-month and 6-month postoperative follow-up, no significant differences were found between groups A and B in terms of the incidence of dysphagia (p > 0.05). In the 6-month postoperative follow-up, no significant differences were found between the groups in terms of SWAL-QOL scores (p > 0.05). There were no significant differences in APSTT between groups during postoperative follow-up (p > 0.05). CONCLUSION: The reconstructions of LCM and ALL in ACS can effectively improve short-term postoperative swallowing function.

Acute Calcific Tendinitis of the Longus Colli Muscle Masquerading as Acute Meningitis: A Case Report and Review of the Literature.

We present a case report of a young female who presented with acute neck pain, odynophagia, and fever. These symptoms were suggestive of possible differential diagnosis including meningitis and retropharyngeal abscess. Subsequent radiological investigations led to a diagnosis of acute calcific tendonitis of the longus colli muscle. Typical clinical presentations and radiological findings of this rare condition are discussed.

An Unusual Cause of Fever, Neck Pain, and Neck Stiffness: Acute Calcific Tendinitis of the Longus Colli Muscle.

BACKGROUND: Acute calcific tendinitis (ACT) of the longus colli muscle (LCM) is an inflammatory response due to deposition of calcium hydroxyapatite crystals. It is typically correlated with whiplash and overuse injuries. A common presentation of this inflammatory response is acute but progressive neck pain. It is a rare but important cause of neck pain that should be considered on a differential diagnosis when distinguishing between life-threatening conditions and non-life-threatening causes of neck pain. CASE REPORT: A 51-year-old woman presented to the emergency department (ED) reporting a mild sore throat that progressed to acute neck pain and stiffness. She also reported fatigue, fever, myalgias, and nausea. In the ED, the patient was tachycardic, hypertensive, and mildly febrile with normal oxygen saturation. Examination revealed meningismus and was negative for lymphadenopathy, oropharyngeal findings, and neurologic deficits. Laboratory studies were significant for leukocytosis. Computed tomography (CT) neck was obtained and was notable for calcification of the superior left longus colli muscle with prevertebral and retropharyngeal space edema along the muscle body. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: ACT of the LCM is a benign, self-limited condition that can present with features overlapping emergent causes of acute neck pain. Correct diagnosis relies on characteristic radiographic findings on CT. Fortunately, patients may be discharged home with a short course of anti-inflammatories and corticosteroids with near-complete resolution of symptoms. Emergency physicians, therefore, can rule out life-threatening causes of neck pain, while also making a definitive diagnosis and initiating effective management for this pathology.

Acute Calcific Tendinitis of the Longus Colli Muscle.

A man in his 40s complained of posterior neck pain and headache after a local festival. The patient also developed mild fever, odynophagia, and difficulty opening his mouth widely. Physical examination revealed mild rightward torticollis and limited ranges of neck motion. A neck computed tomography (CT) revealed calcification on the tendon of the lingus colli muscle. The pain decreased rapidly after acetaminophen and loxoprofen administration. Physicians should recognize the clinical characteristics of acute calcific tendinitis of the longus colli muscle (ACTLC) and conduct thorough follow-ups to exclude infection.

Morphologic Changes of Cervical Musculature in Relation to Chronic Nonspecific Neck Pain: A Systematic Review and Meta-Analysis.

BACKGROUND: Chronic neck pain is a common musculoskeletal disorder. Previous studies have found that chronic neck pain is associated with changes in neck muscle morphology and fat infiltration (FI). This systematic review summarizes and analyzes all studies on neck muscle morphology in patients with chronic nonspecific neck pain (CNNP). The main objective of this study was to review and analyze measurements of neck muscles in all patients with CNNP, including morphologic changes in the multifidus muscle (MF), longus colli muscle (LC), and semis-spinalis capitis muscle (SCa) in patients with CNNP compared with controls. METHODS: This was a systematic review with meta-analysis A comprehensive search of online databases, including PubMed, Web of Sciences, Embase, and Medline was conducted to identify relevant studies reporting changes in neck muscle morphology in patients with chronic neck pain versus healthy controls. Search scope was from inception to June 30, 2022, with no language restrictions. Two reviewers participated in the screening process independently. Due to the lack of relevant data from other studies, only studies that reported morphologic changes of MF, LC, and SCa in patients with CNNP, including muscle cross-sectional area (CSA), lateral diameter (LD), and anteroposterior diameter (APD), were selected. A modified Newcastle-Ottawa scale was used to assess study quality and risk of bias. A total of 11 studies were included based on inclusion and exclusion criteria, of which 8 were included in the meta-analysis. RESULTS: The results showed that the CSA of LC was slightly smaller in patients with CNNP (mean difference-0.23, 95% confidence interval -0.37 to -0.08), and the multiplied linear dimensions (multiplied linear dimensions: lateral diameter × anteroposterior diameter) of SCa was slightly smaller (mean difference -0.19, 95% confidence interval -0.34 to -0.03). There was no difference in MF muscle size between Patients with CNNP and healthy controls. CONCLUSIONS: LC and SCa sizes were slightly smaller in patients with CNNP; there was no difference in MF muscle size between the 2 groups. In addition, no conclusions could be drawn in fat infiltration due to insufficient evidence. In summary, CNNP has influence on neck muscle morphology but the evidence is limited.

[Retropharyngeal tendinitis : Rare differential diagnosis of acute neck pain]. / Retropharyngeale Tendinitis : Seltene Differenzialdiagnose bei akuten Nackenschmerzen.

Atraumatic neck pain is a frequent reason for patients to attend the emergency department (ED). It remains a challenge for the treating physician to rule out possible life-threatening causes, such as a retropharyngeal abscess, meningitis or septic spondylodiscitis. Herein, we report the rare case of a patient suffering from retropharyngeal tendinitis. This rare cause of atraumatic neck pain is characterized by a significant decrease in the range of motion of the cervical spine, elevated infection parameters and pathognomonic MRI findings. In addition to presenting the rare case of retropharyngeal tendinitis, we also review selected previous case reports and thereby not only raise awareness for this rare disease but also suggest the best practice for treatment.

Clinical and Imaging Features of Longus Colli Calcific Tendinitis: An Analysis of Ten Cases.

BACKGROUND: Longus colli calcific tendinitis (LCCT) exhibits characteristic clinical features; thus, misidentification can be avoided once it is learned. There is a lack of reports on this disease. In this study, we analyzed the imaging and clinical features of LCCT in 10 patients. METHODS: We retrospectively reviewed the radiolographic findings, laboratory data and clinical features of 10 patients diagnosed with LCCT between January 2015 and June 2017. All patients were treated with medical treatment consisting of intravenous methylprednisolone 125 mg twice and oral nonsteroidal anti-inflammatory drug administration. RESULTS: On clinical findings, all 10 patients complained of severe posterior neck pain and cervical motion limitation. Odynophagia was present in nine patients. The mean time from symptom onset to hospital visit was 2.9 days. The mean time to symptom relief was 4.6 days. Of the 10 patients, three patients were admitted through the emergency room. There were five patients in the medical records who were transferred from another hospital. On the laboratory data, the mean value of C-reactive protein and erythrocyte sedimentation rate were 2.08 mg/dL (reference range, < 0.30 mg/dL) and 36.9 mm/hr (reference range, < 20 mm/hr), respectively. Leukocytosis was found in only two patients and fever was not present all patients. On radiographic findings, calcification was present on computed tomography images of all patients. The calcification was located at the lower part of the C1 arch, except for one case where calcification occurred in the anterolateral aspect of the C4-5 disc space. The mean value of the retropharyngeal space was 7.2 mm. CONCLUSIONS: LCCT, a rare disease, has characteristic radiographic findings and clinical features. Understanding such characteristics of this disease can prevent unnecessary testing and misdiagnosis.

Clinical and Imaging Features of Longus Colli Calcific Tendinitis: An Analysis of Ten Cases

BACKGROUND: Longus colli calcific tendinitis (LCCT) exhibits characteristic clinical features; thus, misidentification can be avoided once it is learned. There is a lack of reports on this disease. In this study, we analyzed the imaging and clinical features of LCCT in 10 patients. METHODS: We retrospectively reviewed the radiolographic findings, laboratory data and clinical features of 10 patients diagnosed with LCCT between January 2015 and June 2017. All patients were treated with medical treatment consisting of intravenous methylprednisolone 125 mg twice and oral nonsteroidal anti-inflammatory drug administration. RESULTS: On clinical findings, all 10 patients complained of severe posterior neck pain and cervical motion limitation. Odynophagia was present in nine patients. The mean time from symptom onset to hospital visit was 2.9 days. The mean time to symptom relief was 4.6 days. Of the 10 patients, three patients were admitted through the emergency room. There were five patients in the medical records who were transferred from another hospital. On the laboratory data, the mean value of C-reactive protein and erythrocyte sedimentation rate were 2.08 mg/dL (reference range, < 0.30 mg/dL) and 36.9 mm/hr (reference range, < 20 mm/hr), respectively. Leukocytosis was found in only two patients and fever was not present all patients. On radiographic findings, calcification was present on computed tomography images of all patients. The calcification was located at the lower part of the C1 arch, except for one case where calcification occurred in the anterolateral aspect of the C4–5 disc space. The mean value of the retropharyngeal space was 7.2 mm. CONCLUSIONS: LCCT, a rare disease, has characteristic radiographic findings and clinical features. Understanding such characteristics of this disease can prevent unnecessary testing and misdiagnosis.

Surgical Anatomy of the Longus Colli Muscle and Uncinate Process in the Cervical Spine.

PURPOSE: There have been a few previous reports regarding the distances between the medial borders of the longus colli to expose the disc space. However, to our knowledge, there are no reports concerning longus colli dissection to expose the uncinate processes. This study was undertaken to assess the surgical relationship between the longus colli muscle and the uncinate process in the cervical spine. MATERIALS AND METHODS: This study included 120 Korean patients randomly selected from 333 who had cervical spine MRIs and CTs from January 2003 to October 2013. They consisted of 60 males and 60 females. Each group was subdivided into six groups by age from 20 to 70 years or more. We measured three parameters on MRIs from C3 to T1: left and right longus colli distance and inter-longus colli distance. We also measured three parameters on CT: left and right uncinate distance and inter-uncinate distance. RESULTS: The longus colli distances, uncinate distances, and inter-uncinate distances increased from C3 to T1. The inter-longus colli distances increased from C3 to C7. There was no difference in longus colli distances and uncinate distances between males and females. There was no difference in the six parameters for the different age groups. CONCLUSION: Although approximate guidelines, we recommend the longus colli be dissected approximately 5 mm at C3-5, 6 mm at C5-6, 7 mm at C6-7, and 8 mm at C7-T1 to expose the uncinate process to its lateral edge.

MRI Findings of Injury to the Longus Colli Muscle in Patients With Neck Trauma.

OBJECTIVE: The longus colli muscle (LCM) forms the bulk of the deep flexor muscles of the neck. To our knowledge, very little information on the effects of trauma on this muscle group has been published. We describe MRI findings related to injury of the LCM in patients with a history of neck trauma. MATERIALS AND METHODS: A radiology department database was searched to identify patient medical records from 2008 to 2013 that included the keywords "longus colli" and "deep flexors." Patients with fractures and ligament injuries were excluded. Patients with other obvious large soft-tissue injuries and nontraumatic conditions were also omitted. A total of 12 patients met the inclusion criterion of having an isolated or predominant injury to the LCM. Five patients had been involved in a motor vehicle accident, and seven patients had fallen. Eleven patients had undergone a CT examination before MRI was performed. RESULTS: No fractures were noted on CT. MRI examinations of the cervical spine were obtained for the following reasons: for increased prevertebral soft-tissue swelling noted on a CT scan plus neck pain (n = 6), for neck pain only (n = 4), or as part of a routine protocol for assessment of obtunded patients (n = 2). Eight of the 12 patients had isolated injury to the LCM. The remaining four patients also had minor injuries to the other neck muscles. The MR image showed swelling and T2 hyperintensity in the LCM and revealed free fluid in the prevertebral space. CONCLUSION: Isolated injury to the LCM may occur in neck injuries. The MRI findings indicating such injury include increased T2 signal, swelling of the muscle, and the presence of prevertebral fluid.

A Rare Cause of Dysphagia to Remember: Calcific Tendinitis of the Longus Colli Muscle.

Longus colli tendinitis (LCT) is an acute inflammatory condition with symptoms typically consisting of acute neck pain and stiffness with or without dysphagia. Once more severe etiologies for these symptoms are ruled out, this self-limiting condition usually resolves spontaneously with nonsteroidal anti-inflammatory drugs and corticosteroids. We present a case of LCT that presented as acute neck pain, dysphagia, and odynophagia that rapidly resolved once diagnosed and treated with anti-inflammatory agents. Though exceedingly rare, LCT must be considered in the differential diagnosis of acute neck pain, dysphagia, and odynophagia when more common etiologies do not correlate with the clinical presentation.

A morphometric analysis of the superior cervical ganglion and its surrounding structures.

PURPOSE: The aim of this cadaveric study was to detect the superior cervical ganglion (SCG) in a topographic manner according to vertebrae and to determine the relationship between the vertebrae, mandibular angle and longus colli muscle through morphometric analysis. METHODS: The present study was performed on 40 SCG of 20 human cadavers (16 males, 4 females). The level of the SCG was determined based on the vertebrae. Ganglion length, width and thickness were detected. Distance to the adjacent vertebra, the mandibular angle and medial side of the longus colli muscle were measured. The results were evaluated statistically. RESULTS: The SCG existing in all cadavers was detected at the C2 vertebra level in 34 cadavers and at the C3 vertebra level in 6 cadavers. The average length, width and thickness of the SCG were 15.18 ± 1.12, 4.62 ± 0.25, and 1.83 ± 0.10 mm, respectively. No statistically significant difference was detected in terms of the distances between the ganglion and anterior tubercle of transverse processes of the vertebrae as well as the mandibular angle on either side. The distance between the SCG and the medial edge of the longus colli muscle was significantly greater on the left side in both men (p < 0.001) and women (p < 0.01). CONCLUSION: Recognition of morphometric characteristics of the SCG and detection of its location according to adjacent formations may serve as a guide for nerve blockage studies and help surgeons to preserve the ganglion in both anterior and anterolateral cervical approaches.

Surgical Anatomy of the Longus Colli Muscle and Uncinate Process in the Cervical Spine

PURPOSE: There have been a few previous reports regarding the distances between the medial borders of the longus colli to expose the disc space. However, to our knowledge, there are no reports concerning longus colli dissection to expose the uncinate processes. This study was undertaken to assess the surgical relationship between the longus colli muscle and the uncinate process in the cervical spine. MATERIALS AND METHODS: This study included 120 Korean patients randomly selected from 333 who had cervical spine MRIs and CTs from January 2003 to October 2013. They consisted of 60 males and 60 females. Each group was subdivided into six groups by age from 20 to 70 years or more. We measured three parameters on MRIs from C3 to T1: left and right longus colli distance and inter-longus colli distance. We also measured three parameters on CT: left and right uncinate distance and inter-uncinate distance. RESULTS: The longus colli distances, uncinate distances, and inter-uncinate distances increased from C3 to T1. The inter-longus colli distances increased from C3 to C7. There was no difference in longus colli distances and uncinate distances between males and females. There was no difference in the six parameters for the different age groups. CONCLUSION: Although approximate guidelines, we recommend the longus colli be dissected approximately 5 mm at C3-5, 6 mm at C5-6, 7 mm at C6-7, and 8 mm at C7-T1 to expose the uncinate process to its lateral edge.

Acute Prevertebral Calcific Tendinitis.

We present a case of neck pain in a middle-aged woman, initially attributed to a retropharyngeal infection and treated with urgent intubation. With the help of computed tomography, the diagnosis was later revised to acute prevertebral calcific tendinitis, a self-limiting condition caused by abnormal calcium hydroxyapatite deposition in the longus colli muscles. It is critical to differentiate between these two disease entities due to dramatic differences in management. A discussion of acute prevertebral calcific tendinitis and its imaging findings is provided below.

Relationship between cross sectional area of Longus Colli muscle and pain laterality in patients with cervicogenic headache.

BACKGROUND AND OBJECTIVES: Cervicogenic headache (CGH) originated from impaired cervical musculoskeletal structures. Dysfunction of deep neck flexor muscles has been reported in CGH subjects. The purpose of this study was to assess relationship between the size of these muscles and headache laterality in CGH subjects. MATERIAL AND METHOD: A cross sectional single blind study designed to investigate 37 CGH subjects compared with 37 healthy controls. Longus colli (LC) muscle Cross Sectional Area (CSA) in both sides was measured in supine position utilizing diagnostic ultrasonography. RESULTS: The mean CSA of LC muscle in healthy subjects was 0.74 ± 0.06 cm2 and in patients suffering from CGH was 0.74 ± 0.06 cm2 in left and 0.75 ± 0.06 cm<2 in right side. No significant difference was found between subjects suffering from CGH compared with healthy controls. Also no difference was found between muscle size of affected and non-affected side in unilateral CGH subjects. CONCLUSIONS: Results indicated that there was no relationship between size of LC muscle and pain laterality in patients with CGH.

Aspectos de imagem na tendinite calcária pré-vertebral / Imaging findings in acute calcific prevertebral tendinitis

A tendinite calcária aguda pré-vertebral é uma condição benigna e rara que apresenta calcificação das fibras do músculo longo do pescoço com reação inflamatória local, sendo esta uma das formas de apresentação menos frequentes da doença por deposição de hidroxiapatita de cálcio. Manifesta-se com dor cervical aguda e/ou odinofagia, podendo ser erroneamente diagnosticada como abscesso retrofaríngeo, espondilodiscite ou alteração decorrente de trauma. Os achados radiológicos na tendinite calcária pré-vertebral são patognomônicos. O conhecimento de tais achados é muito importante, pois o correto diagnóstico possibilita a resolução precoce dos sintomas e evita intervenções desnecessárias em um paciente que apresenta afecção com boa resposta ao tratamento conservador.

Acute calcific prevertebral tendinitis is a benign and rare condition that presents calcification of the superior oblique fibers of longus colli muscle with local inflammatory reaction. Such condition is one of the less common presentations of calcium hydroxyapatite deposition disease. Clinical signs are usually acute neck pain and odynophagia, and it may be misdiagnosed as retropharyngeal abscess, spondylodiscitis or traumatic injury. The imaging findings in calcific prevertebral tendinitis are pathognomonic. The knowledge of such findings is extremely important to avoid unnecessary interventions in a patient presenting a condition with a good response to conservative treatment.

Acute retropharyngeal calcific tendinitis in an unusual location: a case report in a patient with rheumatoid arthritis and atlantoaxial subluxation.

Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.

Acute Retropharyngeal Calcific Tendinitis in an Unusual Location: a Case Report in a Patient with Rheumatoid Arthritis and Atlantoaxial Subluxation

Retropharyngeal calcific tendinitis is defined as inflammation of the longus colli muscle and is caused by the deposition of calcium hydroxyapatite crystals, which usually involves the superior oblique fibers of the longus colli muscle from C1-3. Diagnosis is usually made by detecting amorphous calcification and prevertebral soft tissue swelling on radiograph, CT or MRI. In this report, we introduce a case of this disease which was misdiagnosed as a retropharyngeal tuberculous abscess, or a muscle strain of the ongus colli muscle. No calcifications were visible along the vertical fibers of the longus colli muscle. The lesion was located anterior to the C4-5 disc, in a rheumatoid arthritis patient with atlantoaxial subluxation. Calcific tendinitis of the longus colli muscle at this location in a rheumatoid arthritis patient has not been reported in the English literature.