Acute Calcific Tendonitis of the Longus Colli

Aka: Acute Calcific Tendonitis of the Longus Colli, Longus Colli Tendonitis, ACTLC

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II. Epidemiology

  1. Ages 30 to 60 years old
  2. No significant gender predisposition
  3. Uncommon: 0.5 cases per 100,000 person years

III. Pathophysiology

  1. Longus coli is one of 4 cervical flexor Muscles
  2. Calcific Tendonitis develops within the longus coli Muscle tendons
    1. Superior aspect tendons are most susceptible (C1 to C3, down to C5 region)
    2. Calcium deposits within tendon as a response to decreased local strength
    3. Tendon rupture results in release of hydroxyapatite crystals into soft tissue
    4. Local crystal release results in aseptic inflammatory response
  3. Precipitating injuries
    1. Repetitive Trauma with secondary localized tendon ischemia and necrosis
  4. Course
    1. Resolves spontaneously over weeks
    2. Resolves as hydroxyapatite crystals are phagocytosed by Macrophages

IV. Symptoms

  1. Acute Neck Pain
  2. Neck stiffness and decreased range of motion
  3. Dysphagia
  4. Odynophagia
  5. Globus Hystericus
  6. Low grade fever

V. Labs

  1. Leukocytosis (mild)
  2. Inflammatory markers (e.g. CRP) mildly increased

VI. Imaging

  1. CT Cervical Spine
    1. Gold standard for identifying specific calcification changes of ACTLC
    2. Calciium deposition within the longus colli
    3. Prevertebral edema
      1. Rim enhancement is absent in ACTLC (but present in abscess)

VII. Differential Diagnosis

  1. See Neck Pain
  2. See Odynophagia
  3. See Globus Hystericus
  4. Retropharyngeal Abscess
  5. Meningitis
  6. Spinal Epidural Abscess
  7. Spinal Epidural Hematoma
  8. Cervical Disc Herniation
  9. Vertebral Fracture

VIII. Management

  1. Conservative management
    1. Resolves over the course of weeks spontaneously
    2. No indication for extracorporeal shock wave therapy or surgery
  2. Analgesics and antiinflammatory agents
    1. NSAIDs
    2. Corticosteroids

IX. References

  1. Raggio (2018) Ochsner J 18(1):98-100 +PMID: 29559880 [PubMed]
  2. Zibis (2013) Eur Spine J 22(Suppl 3):S434-8 +PMID: 23179983 [PubMed]

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