Longus capitis is the uppermost of the deep cervical flexors, originating from the C3-C6 transverse processes and attaching to the basilar occipital bone. It works synergistically with longus colli and the rectus capitis anterior to flex and stabilize the upper cervical spine. Its tonic activation is tested by the craniocervical flexion test (CCFT) using pressure biofeedback.
| Origin | Anterior tubercles of transverse processes of C3-C6 |
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| Insertion | Basilar part of occipital bone, anterior to foramen magnum |
| Nerve Supply | Ventral rami of C1-C3 |
| Blood Supply | Ascending pharyngeal artery; ascending cervical artery |
| Actions | Flexes the head on the neck (craniovertebral flexion); with longus colli, constitutes the deep cervical flexor group responsible for segmental cervical stability and the craniocervical flexion test activation pattern |
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Longus capitis atrophy is documented by MRI in chronic neck pain, whiplash, and cervicogenic headache, correlating with disability and predicting poor outcomes. Anterior cervical discectomy requires retraction or partial division of the longus capitis to expose the C1-C2 anterior vertebral bodies in high cervical approaches. The nasopharyngeal carcinoma staging uses the longus capitis as the posterior boundary of the parapharyngeal space on axial MRI.
Anterior approaches to C1-C2 require identification and gentle medial retraction of the longus capitis from the anterior atlas and axis; overly aggressive retraction or thermal injury from monopolar cautery damages the muscle and may injure the adjacent hypopharynx or Eustachian tube opening in the nasopharynx above.
