Cervical Spine and Swallowing Disorders

Cervical spine stenosis can cause dysphagia through structural compression and functional abnormalities affecting the pharynx and esophagus, as noted by the American College of Radiology 1

Diagnostic Mechanisms

Dysphagia related to cervical spine stenosis typically occurs through direct mechanical compression and functional abnormalities, according to the American College of Radiology 1
Imaging studies, including CT of the neck with IV contrast, single-contrast esophagram, and modified barium swallow, are useful for assessing the position of surgical hardware, postoperative anatomy, and swallowing dysfunction, as recommended by the American College of Radiology 1
Modified barium swallow evaluates oral and pharyngeal phases of swallowing 1
Videofluoroscopy assesses bolus manipulation, tongue motion, hyoid and laryngeal elevation, and cricopharyngeal function 1
Biphasic esophagram is important to evaluate the entire esophagus, as distal esophageal or gastric cardia lesions can cause referred dysphagia to the pharynx 1

Post-cervical spine surgery patients are at high risk for dysphagia, as reported by the American College of Radiology 1
Dysphagia can lead to aspiration pneumonia, malnutrition, and reduced quality of life, especially in elderly people with central swallowing disorders, such as stroke, Parkinson's disease, and dementia, according to Clinical Nutrition 2, 3
Stroke affects at least 50% of patients with ischemic or hemorrhagic stroke, leading to a three-fold increased risk of aspiration pneumonia 3
Parkinson's disease is a major risk factor for pneumonia, the most frequent cause of death in this population 3
Amyotrophic Lateral Sclerosis (ALS) presents with swallowing impairment at diagnosis in up to 30% of cases, and virtually all develop dysphagia as disease progresses 3
Multiple Sclerosis occurs in more than one-third of patients 3
Dementia causes progressive cognitive decline affecting swallowing coordination 1
Myasthenia gravis presents with dysphagia in 15% of cases, and over 50% develop dysphagia as disease progresses 3
Inflammatory myopathies, including dermatomyositis, polymyositis, and inclusion body myositis, can cause dysphagia in 20-86% of cases 3

Pharyngeal or cricopharyngeal strictures can cause dysphagia 4
Oropharyngeal tumors can cause dysphagia 4
Posterior pharyngeal diverticulum can cause dysphagia 4
Cervical webs can cause dysphagia 4
Thyroid nodules can cause dysphagia when they compress surrounding structures 5
Cricopharyngeal bars can cause dysphagia 4
Cervical osteophytes or skeletal hyperostosis can cause dysphagia 4
Upper esophageal sphincter dysfunction, including hyperfunction, can lead to hypopharyngeal retention of swallowed material and subsequent aspiration 4
Presbyphagia, age-related multifactorial changes in swallowing physiology, can cause dysphagia 3

Patients with pharyngeal dysphagia typically complain of food sticking in the throat, globus sensation, coughing/choking during swallowing, nasal-quality voice, nasal regurgitation, food dribbling, and difficulty initiating swallow 1
Reflexive cough during eating or drinking has a sensitivity of 74% and specificity of 74% for aspiration in neurologically impaired patients 4

Texture-modified diets may be recommended for patients with dysphagia, as suggested by Clinical Nutrition 2
A comprehensive evaluation, including assessment of both structural and functional abnormalities, is crucial for accurate diagnosis and treatment of cervical spine-related dysphagia, as implied by the American College of Radiology 1
In patients with unexplained oropharyngeal dysphagia, a complete examination of the esophagus should be performed, as 68% of patients with complaints of dysphagia for solids have abnormal esophageal transit, and in one-third of these cases, the esophageal abnormality is the only finding 1