Can cervical spine stenosis cause dysphagia?

Cervical Spine Stenosis as a Cause of Dysphagia

Yes, cervical spine stenosis can cause dysphagia through both structural compression and functional abnormalities affecting the pharynx and esophagus. 1

Mechanism of Cervical Spine-Related Dysphagia

Dysphagia related to cervical spine stenosis typically occurs through several mechanisms:

1. Direct mechanical compression:

   • Anterior osteophytes or bone spurs can directly compress the pharynx and esophagus 1, 2
   • Displaced surgical hardware or bone grafts following cervical spine surgery 1
   • Ossification of the anterior longitudinal ligament (OALL) 3

2. Functional abnormalities:

   • Changes in physiological curvature of the cervical spine (kyphosis) 2, 4
   • Decreased mobility of the cervical spine affecting swallowing mechanics 4
   • Changes in elasticity and contractility of neck muscles 4

Clinical Presentation

Patients with cervical spine stenosis-related dysphagia may present with:

• Food sticking in the throat 5
• Globus sensation 5
• Coughing or choking during swallowing 5
• Difficulty initiating swallow 5
• Dysphagia primarily for solid foods 2

Diagnostic Approach

For patients with suspected cervical spine-related dysphagia:

1. Imaging studies:

   • CT of the neck with IV contrast: Useful to assess the position of surgical hardware or complications related to surgical hardware with respect to the oropharynx and airway 1
   • Single-contrast esophagram: Defines postoperative anatomy and caliber of the pharynx and esophagus, assessing for stricture and extrinsic compression 1
   • Modified barium swallow: Appropriate when oropharyngeal dysmotility is suspected, particularly with concerns for swallowing dysfunction including penetration or aspiration 1, 5

2. Comprehensive evaluation:

   • Evaluate for both structural and functional abnormalities
   • Consider that abnormalities of the mid or distal esophagus may cause referred dysphagia to the pharynx 5
   • Complete examination of the esophagus is recommended as 68% of patients with dysphagia for solids have abnormal esophageal transit 5

Clinical Considerations

1. High-risk populations:

   • Elderly patients with degenerative cervical spine disease 4
   • Patients with diffuse idiopathic skeletal hyperostosis (DISH) 6
   • Post-cervical spine surgery patients 1

2. Comorbidities:

   • Cervical spine disorders are common additional causes of dysphagia in elderly people with central swallowing disorders (stroke, Parkinson's disease, dementia) 4
   • Dysphagia can lead to aspiration pneumonia, malnutrition, and reduced quality of life 1

Management Approaches

1. Conservative treatment:

   • Physical therapy and manual therapy to improve cervical spine mobility 4
   • Soft tissue techniques and stretching of shortened muscles 4
   • Passive and active mobilization of facet joints 4
   • Texture-modified diets for patients with dysphagia 1

2. Surgical intervention:

   • Removal of anterior osteophytes or ossification of the anterior longitudinal ligament when conservative measures fail 3
   • Simultaneous decompression of associated posterior elements if spinal stenosis is present 3

Important Pitfalls to Avoid

1. Missing the diagnosis: Cervical spine disorders are often overlooked as causes of dysphagia 4

2. Incomplete evaluation: Always evaluate the entire esophagus in patients with dysphagia, as distal esophageal or gastric cardia lesions can cause referred dysphagia to the pharynx 5

3. Failure to consider multiple causes: Dysphagia is often multifactorial, especially in elderly patients 6

4. Overlooking neurological involvement: In patients with cervical spine stenosis and dysphagia, a precise neurological examination is critical to identify associated spinal cord or nerve root compression 3

5. Preoperative planning: Consider routine preoperative imaging of the cervical spine in patients with DISH undergoing spine surgery to stratify risk for postoperative dysphagia 6