The longus colli is the primary deep cervical flexor, lying directly on the anterior vertebral bodies. It is assessed by the deep neck flexor endurance test (chin tuck position) and is specifically trained in cervicogenic headache and whiplash rehabilitation. Deep neck flexor weakness (longus colli and longus capitis) is the most consistent finding in chronic neck pain and headache from whiplash.
| Origin | Anterior vertebral bodies and transverse processes of C3-T3 — three portions: superior oblique (C3-C5 transverse processes to anterior arch of atlas), inferior oblique (T1-T3 bodies to C5-C6 transverse processes), vertical (C5-T3 bodies to C2-C4 bodies) |
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| Insertion | Anterior arch of the atlas (superior oblique), anterior tubercle of C5-C6 transverse processes (inferior oblique), C2-C4 vertebral bodies (vertical) |
| Nerve Supply | Ventral rami of C2-C6 (direct cervical nerve branches) |
| Blood Supply | Ascending cervical and vertebral arteries |
| Actions | Cervical flexion (primary deep anterior cervical flexor — the 'deep neck flexor'); Ipsilateral lateral flexion; The superior oblique portion flexes and rotates the upper cervical spine |
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Retropharyngeal calcific tendinitis (calcium deposition in the longus colli tendon) produces severe acute neck pain with odynophagia and prevertebral soft tissue swelling on lateral neck X-ray. CT shows calcification at C1-C2 in the longus colli tendon. It resolves spontaneously with NSAIDs and analgesia.
The longus colli is not palpable from the surface — assessed indirectly by the deep neck flexor endurance test (chin tuck held against gravity).
Acute longus colli calcium deposition producing severe neck pain and prevertebral swelling managed with NSAIDs — resolves spontaneously.
