Compartment
A cylinder of soft tissue enclosed by the prevertebral layer of the deep cervical fascia, extending from the skull base to the upper mediastinum.
Perivertebral Space
The perivertebral space is a deep compartment of the head and neck comprising the prevertebral and paraspinal spaces, posterior to the retropharyngeal and danger spaces.
Reference Images
Subdivisions
A deep fascial slip to the transverse process separates the anterior prevertebral and posterior paraspinal portions.
Imaging
CT depicts bone destruction. MRI is preferred for soft-tissue assessment and detection of early spinal infection. [1]
Terminology
The supplied teaching slide describes the historical use of “prevertebral space” as including soft tissues behind the vertebral column. “Perivertebral space” (PVS; peri means around) includes tissues both in front of and behind the column beneath the deep layer of the deep cervical fascia.
Gross anatomy and boundaries
| Boundary | Description |
|---|---|
| Anterior | Danger space and retropharyngeal space |
| Posterior | Fascia attaches to the spinous process and ligamentum nuchae |
| Lateral | Surrounded by the posterior cervical space |
| Superior | Base of skull |
| Inferior | Usually defined to the superior mediastinum; the supplied text also describes extension to the coccyx. |
The cervical definition above is the usual extent used in the supplied material; the broader description to the coccyx is retained as a source qualification.
Contents [1]
Prevertebral portion
- cervical vertebral body and disc
Prevertebral muscles
- longus colli
- longus capitis
- rectus capitis anterior and lateralis
Scalene muscles
- scalenus anterior
- scalenus medius
- scalenus posterior
- vertebral artery and vein
- phrenic nerve
- roots of brachial plexus
Paraspinal portion
- vertebral arches of cervical vertebrae
Cervical paraspinal muscles
Suboccipital muscle group
- rectus capitis posterior major and minor
- obliquus capitis superior and inferior
Extrinsic back muscles
- levator scapulae
- rhomboid minor
Superficial layer of intrinsic back muscles
- splenius capitis
- splenius cervicis
Intermediate layer of intrinsic back muscles: erector spinae group
- longissimus capitis and cervicis
- iliocostalis cervicis
- spinalis cervicis and capitis
Deep layer of intrinsic back muscles: transversospinalis group
- semispinalis capitis and cervicis
- multifidus cervicis
- rotatores cervicis
- interspinales cervicis
- intertransversarii
Prevertebral soft-tissue thickness
On sagittal imaging, the prevertebral component is generally measured from the anterior vertebral-body border to the air within the pharynx or trachea. Thickness varies with body build and normal variation. No definitive cutoff perfectly separates patients with injury from those without injury; sensitivity and specificity depend on the threshold selected.
| Level | Measurement |
|---|---|
| C2/3 | <7 mm |
| C6/7 | <21 mm |
Values above these measurements produced a true positive rate of 53% and a false positive rate of 5% in that study. [7]
| Level | Thickness |
|---|---|
| C1 | 8.5 mm |
| C2 | 6 mm |
| C3 | 7 mm |
| C4/C5 | Variable because of variable cricoid/esophageal height |
| C6 | 18 mm |
| C7 | 18 mm |
Pediatric values differ and are more variable because of superior adenoidal tissue and smaller size.
| Age (years) | C2 | C6 |
|---|---|---|
| 0–2 | 7.6 mm | 9.0 mm |
| 3–6 | 8.4 mm | 9.8 mm |
| 7–10 | 6.8 mm | 12.1 mm |
| 11–15 | 6.8 mm | 14.5 mm |
Mass localization and spread
- A prevertebral mass is centered on the vertebral body or prevertebral muscles and displaces the muscles anteriorly. A retropharyngeal mass instead flattens the prevertebral muscles posteriorly against the vertebral body. [1]
- A paraspinal mass displaces paraspinal musculature and posterior cervical space fat away from the spine. [1]
- Extension of benign and malignant lesions from the perivertebral space into the epidural space is common. [1]
CT
- Useful for identifying details of bone destruction. [1]
- Postoperative or spontaneous abscess may be differentiated from noninfected fluid by rim enhancement, surrounding fat stranding, muscle swelling and skin thickening. [3]
- Longus colli tendinitis: prevertebral soft-tissue swelling anterior to C2–3, associated with tendon calcification. [1]
- Chordomas are rare, aggressive tumors arising from axial skeletal notochordal remnants. The mass is typically hypodense/isodense with lytic vertebral destruction and may extend over multiple levels. [2]
MRI
Preferred for assessing soft tissues in this space and detecting early spinal infection. [1]
Vertebral osteomyelitis
Acute marrow edema produces low T1-weighted and high T2-weighted signal, especially with fat-saturated techniques, spectroscopic inversion recovery (SPIR) or short tau inversion recovery (STIR) sequences. [4]
Vertebral lymphoma
The described “wrap-around” sign is tumor in marrow and paraspinal soft tissue without alteration of the normal vertebral shape. This may help differentiate lymphoma from metastasis and myeloma, which tend to destroy the cortex and produce a bulging contour.
- T1: hypointense with high signal post-contrast.
- T2: “hyperintense with contrast enhancement.” [5]
Source limitation: The T2 phrase is reproduced as supplied; the sequence attribution of contrast enhancement is ambiguous and has not been resolved.
Chordoma
Homogeneous hypointense/isointense lesions on T1-weighted images, hyperintense on T2-weighted images, with post-gadolinium high signal. Tumor develops within vertebral bodies, frequently invades the perivertebral/epidural spaces and may span several vertebral segments. [2]
Related pathology
- Retropharyngeal abscess
- Osseous metastases
- Chordoma
- Osteomyelitis
- Schwannoma
- Osteochondromas
- Direct invasion by squamous cell carcinoma
- Pseudotumors
- Anterior herniated disc
- Vertebral osteophytes
- Calcific tendinitis of the longus colli muscle
- Lymphoma
Benign lesions listed in the supplied slide
Lymphangioma, hemangioma, osteophytes, nodes, lipoma, schwannoma and benign bone lesions. The slide’s “Perivertebral Space-IH” heading is retained in the original image; the suffix is not defined in the supplied material.
Source notes
This page organizes the supplied text and two teaching slides. Bracketed numbers [1–8] preserve the source’s reference markers; no bibliography was supplied, so the cited studies cannot be identified from this material. The numerical values and study performance above are retained as source-specific findings rather than universal diagnostic cutoffs.