Longus colli is the largest deep cervical flexor, lying directly on the anterior vertebral bodies from the atlas to T3. Its three-part architecture provides fine segmental control of cervical alignment. It is the primary target in deep neck flexor rehabilitation and the surgical landmark for anterior cervical approaches.
| Origin | Three parts: vertical (bodies of C5-T3); superior oblique (transverse processes C3-C5 to anterior atlas arch); inferior oblique (bodies T1-T3 to transverse processes C5-C6) |
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| Insertion | Anterior tubercle of C1 atlas (vertical part); anterior arch of atlas (superior oblique); transverse processes C5-C6 (inferior oblique) |
| Nerve Supply | Ventral rami of C2-C6 |
| Blood Supply | Ascending cervical artery; vertebral artery branches |
| Actions | Flexes the cervical spine (all parts); the superior and inferior oblique parts produce contralateral rotation; the most important deep cervical stabilizer, providing segmental stiffness to the cervical lordosis |
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Longus colli elevation from the cervical vertebral bodies is the first step in all anterior cervical surgical approaches. A Cobb elevator is used to sweep longus colli laterally from the midline, exposing the anterior disc and vertebral body surface. Inadvertent elevation too laterally risks the vertebral artery in the transverse foramen. Postoperative dysphagia after ACDF partly results from retraction oedema of the longus colli. Craniocervical instability from atlantoaxial subluxation is partly driven by longus colli asymmetric weakness.
Bleeding from longus colli vessels during ACDF produces a postoperative retropharyngeal haematoma that can rapidly expand to compress the airway; early recognition of respiratory distress and wound exploration with haematoma evacuation is life-saving, and meticulous haemostasis of the longus colli vessels at surgery reduces the risk.
