Calcific Tendinitis of the Longus Colli Muscle

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Longus colli tendinitis is a misnomer for a condition that lacks a more precise and appropriate name. This condition is also referred to as retropharyngeal tendinitis, and acute calcific tendinitis of the longus colli muscle. But it involves more than just the tendons of the prevertebral muscles.

Epidemiology

It has occasionally been reported in case studies but is considered a rare condition. Its annual incidence in the population is estimated at 1 in 400,000.

Pathophysiology

It is thought to be an inflammatory condition characterized by the deposition of calcium hydroxyapatite crystals in the tendons of the longus colli muscle, with an inflammatory response.

The affected area is the upper portions of the longus colli muscle (not just its tendons), from C1 to C4 and sometimes extending caudally to C6.

The inflammation is often associated with anterior calcification at the level of the C2 vertebra, but this calcification appears to be an epiphenomenon unrelated to the pain, as chronic calcification in the same area can be painless. Inflammation of the longus colli muscle or the prevertebral–retropharyngeal space appears to be the key factor associated with pain.

Clinical Features

This condition typically presents with acute neck pain, neck stiffness, and odynophagia.

Clinically, patients may present with symptoms that mimic more serious conditions such as retropharyngeal abscess, meningitis, or cervical spine trauma. Common symptoms include severe neck pain, reduced range of motion, dysphagia, and sometimes mild fever and leukocytosis.

Imagimg

This can be visualized on imaging studies, particularly computed tomography (CT), which often shows calcifications anterior to the C1-C2 vertebrae and prevertebral soft tissue swelling.

Diagnosis

Diagnosis is primarily based on imaging findings. CT scans are considered the gold standard for identifying the characteristic calcifications and associated prevertebral effusion.

Treatment

Generally conservative, involving nonsteroidal anti-inflammatory drugs (NSAIDs) and sometimes corticosteroids to reduce inflammation and pain. Symptoms typically resolve within a few days to a week with appropriate management.