Longus colli tendinitis. A review of literature and case series

Abstract

Purpose: To increase the awareness of longus colli tendinitis (LCT) among spine specialists and to present a practical overview of diagnostic and treatment options, so that unnecessary interventions are avoided. Five sample cases from a German spine center will also be presented. Methods: Literature review and case series. A PubMed search was performed in May 2015, and the articles found were reviewed for clinical presentation, investigations, and treatment. The frequency of publication of LCT cases and the specialty of journals were also noted. Recent cases treated in our institution were also reviewed. The clinical findings, investigations, and therapeutic interventions were summarized. Results: The PubMed search from May 2015 found 104 articles, published over 51 years, on the topic of LCT. Only four were published in spine journals. A review of this literature yielded a total of 242 cases. The classic clinical triad included neck pain, limitation of movements, and swallowing complaints. C-reactive Protein (CRP) values were available in 21 cases (mean 23.66 mg/dL). A contrast-enhanced computed tomography (CT) scan was the best diagnostic modality. LCT is usually a self-limiting condition, but non-steroidal anti-inflammatory drugs (NSAIDs) may help alleviate discomfort. Five cases of LCT were diagnosed and treated in our center over the past three years. Conclusions: LCT, which is uncommon and has non-specific symptoms, is often referred to spine centers. Spine specialists should be aware of its clinical presentation and radiographic findings in order to avoid unnecessary interventions. The condition is self-limiting and can be treated conservatively.

Longus Colli Tendinitis in a Patient Presenting with Neck Pain and Acute Systemic Inflammation

“…Some cases of LCT, such as our own, do not show calcification on imaging studies, although most do ( 5 ). In cases without calcification, prevertebral effusion on T2-weighted images is important for achieving a diagnosis of LCT.…”

“…On imaging studies, such as CT and MRI, calcification along the longus colli is often noted. A review of the literature that included 242 cases of acute calcific vertebral tendinitis reported by 104 articles revealed that the mean age was 43 years (21-81 years), the CRP values in 21 cases ranged from 0.3 to 91.3 mg/dL (mean 23.66 mg/dL), and the ESR in 45 cases ranged from 5 to 98 mm/h (mean 31.57 mm/h) based on blood tests ( 5 ). The present case showed severe inflammation on blood tests and no calcification on imaging.…”

Laryngeal gout mimicking chondrosarcoma with concurrent longus colli tendinitis

“…The presence of both prevertebral calcification and oedema on CT is considered highly characteristic for acute longus colli tendinitis, and this simultaneous finding should help to distinguish this condition from an infectious aetiology 9 14–17. Other differential diagnoses that can present similarly include retropharyngeal abscess, pharyngitis, spondylitis, vascular conditions 18 19. A retrospective study published in 2017 attempted to determine the frequency of acute longus colli tendinitis on diagnostic CT imaging performed at a large multicenter healthcare system 20.…”

Vertigo caused by longus colli tendonitis

“…The pathophysiologic basis of the condition is a foreign-body inflammatory response to deposited calcium hydroxyapatite in the superior oblique tendon of the longus colli. In studies [ 8 ] that used CT or MRI, calcifications were obvious in 185 cases (approximately 76.44%), and in 190 (78.51%) cases, prevertebral soft-tissue swelling or effusion was present. In 14 (5.7%) cases, there was no comment on the presence of effusion or soft-tissue edema, while in 6 cases soft-tissue swelling or effusion was absent.…”

“…In the published literature, we found no mention of vertigo. Only 1 report [ 8 ] mentioned dizziness and nausea, but no case reports or analysis of vertigo symptoms were reported in the references in this study. [ 9 ] Calcifications were evident in 209 cases (76.8%) in which computer tomography (CT) or MRI were used.…”