Perivertebral Space Overview

Summary Thoughts: Perivertebral Space

The perivertebral space (PVS) is a cylindrical space surrounding the vertebral column, extending from the skull base to the superior mediastinum. The deep layer of the deep cervical fascia (DL-DCF) completely encircles the PVS, which is subdivided into prevertebral (prevertebral-PVS) and paraspinal (paraspinal-PVS) portions or spaces.

A prevertebral space mass will displace the prevertebral muscles anteriorly , distinguishing it from a retropharyngeal space (RPS) mass, which pushes the muscles posteriorly. A paraspinal space mass bows the posterior cervical space (PCS) fat away from the posterior elements of the spine.

The DL-DCF serves as a tenacious barrier to the spread of malignancy or infection, and it will redirect extension of PVS disease to the epidural space .

The vast majority of PVS lesions originate in the vertebral body with metastatic disease and infection topping the list. Therefore, the vertebral body is usually diseased when a PVS lesion is found.

One imaging interpretation pitfall is mistaking a hypertrophic levator scapulae muscle for a mass. The hypertrophy is due to CNXI injury, usually from previous neck dissection. Ipsilateral atrophy of the trapezius and sternocleidomastoid (SCM) muscles help in making the correct diagnosis.