The prevertebral muscles of the head and neck are four in number. They are

1. Rectus capitis anterior muscle
2. Rectus capitis lateralis muscle
3. Longus capitis muscle and
4. Longus colli muscle.

Their origin, insertion, blood supply, nerve supply, and actions have already been explained above.

Researchers found a rare case of the levator scapulae bypassing its typical insertion point on the C1 transverse process and fusing with the inferior attachment of the rectus capitis lateralis muscle through cadaveric findings.[7]

The prevertebral muscles fall into surgical consideration in the development of muscular flaps for reconstructive procedures. The longus capitis is the more commonly utilized prevertebral muscle in these types of cases. The longus capitis is near the cervical sympathetic trunk, superior cervical ganglion, and the carotid sheath. With its close spatial relationship to important structures, the longus capitis can be a pedicled flap for head and neck defect repairs with negligible morbidity.[3] These pedicled flaps can be developed cranially or caudally. The longus capitis has been used for flap reconstruction of the soft palate following squamous cell carcinoma of the tonsils.[12] During transoral surgical resection of oropharyngeal tumors, it rarely results in exposure of the internal carotid artery. This exposed internal carotid artery can result in a very rare but catastrophic complication of rupture and severe bleeding. This complication is preventable by using prevertebral muscle flaps around the internal carotid artery.[13] The oropharyngeal or hypopharyngeal squamous cell carcinomas are more at risk of prevertebral muscle invasion in advanced stages.[14]

The anterior surface of the longus colli communicates with the prevertebral fascia, pharynx, esophagus, the cervical sympathetic trunk, the carotid sheath, the inferior thyroid artery, and the recurrent laryngeal nerve. The posterior surface of the longus colli communicates with the cervical spine. The medial border of the longus colli can be used as a landmark to expose the cervical disc spaces and the uncinate process of the cervical spine during a cervical discectomy or corpectomy procedures as a means to avoid injury to the sympathetic trunk.[15] The longus colli muscle has also been used as an anatomical landmark for ultrasound-guided stellate ganglion blocks, to prevent spread along the carotid sheath.[16]

The rectus capitis lateralis communicates with the internal jugular vein, the vertebral artery, the occipital artery, and the suboccipital nerve. The rectus capitis lateralis can serve as a surgical landmark in a skull base approach for safe exposure of the jugular foramen.[6]

Longus colli tendonitis is a frequent contributor to neck pain and has been investigated as a cause of cervical vertigo.[17] Longus colli tendonitis is diagnosed with MRI or CT imaging and should be suspected in patients who present with rapid onset of neck pain without an obvious discernable cause.[18] Acute calcific tendinitis of the longus colli occurs secondary to calcium deposition within the tissue resulting in an aseptic inflammatory response.[19] It can present clinically with symptoms of fever, acute cervical pain or neck stiffness, globus sensation, and dysphagia. Longus colli tendonitis may present with a modest elevation in C-reactive protein levels and normal white blood cell counts, which can help with the differential of a deep cervical abscess. It is easily misdiagnosed as a retropharyngeal abscess due to the overlap in symptomology.[20]

Muscle invasion of the prevertebral muscle group has been seen in p16+ oropharyngeal squamous cell carcinoma and been used to evaluate local and regional rates of recurrence.[21]

Furthermore, there is a case example of a severe pyomyositis infection of the prevertebral muscles following acupuncture treatment, presenting with pain in the posterior cervical region, torticollis, and high fever.[22]

The prevertebral muscles sometimes undergo an inflammatory process resulting in prevertebral tendinitis. Even though rare, when present, are more commonly found in the cervicothoracic region and usually misdiagnosed as an abscess. They show prevertebral cervical effusion and undergo amorphous calcifications within the prevertebral muscle tendons. MRI is best to detect this condition even though the visualization of the calcifications is better with CT. They also show a slight elevation of CRP and but WBC count is usually within the normal limits.[23]