Can disc space narrowing in the C5-C6 region of the cervical spine cause dysphagia (difficulty swallowing) in an adult with a history of neck pain or degenerative conditions?

Can C5-C6 Disc Space Narrowing Cause Dysphagia?

Yes, C5-C6 disc space narrowing can cause dysphagia (difficulty swallowing), though this typically occurs when degenerative changes produce anterior osteophytes or disc protrusions that mechanically compress the esophagus or pharynx. 1, 2

Mechanism of Cervicogenic Dysphagia

The anatomical proximity of the cervical spine to the pharynx and esophagus allows degenerative changes at C5-C6 to directly impact swallowing structures 1:

• Anterior osteophytes (bone spurs) projecting from the vertebral body can physically compress the posterior esophageal wall 1, 2
• Anterior disc herniation or protrusion may contribute to mechanical obstruction 1, 3
• Changes in cervical curvature (particularly kyphosis) and altered neck muscle elasticity can affect pharyngeal and esophageal dimensions 1, 2
• Chronic multisegmental dysfunction of facet joints may indirectly impair swallowing capacity through altered biomechanics 1

Clinical Presentation Patterns

Patients with cervicogenic dysphagia from C5-C6 pathology typically report 2, 3:

• Difficulty swallowing solids more than liquids (mechanical obstruction pattern)
• Sensation of food sticking in the throat or upper chest
• Sore throat or chronic throat discomfort 2
• Neck pain and stiffness accompanying swallowing difficulties 1, 2

Critical Diagnostic Considerations

When Disc Space Narrowing Alone Is Insufficient

Simple disc space narrowing without anterior osteophytes or significant anterior disc protrusion rarely causes dysphagia. 4 The ACR guidelines emphasize that degenerative changes including disc space narrowing are common in patients over 30 years and correlate poorly with symptoms in isolation 5, 4.

Red Flags Requiring Immediate Evaluation

If dysphagia is present with C5-C6 pathology, evaluate for 5:

• Progressive weight loss or malnutrition (suggests significant obstruction)
• Aspiration symptoms (coughing with swallowing, recurrent pneumonia)
• Complete inability to swallow (R13.0 code - medical emergency) 5
• Neurological symptoms suggesting cord compression rather than mechanical obstruction 4, 6

Diagnostic Workup Algorithm

Step 1: Imaging Assessment

• Lateral cervical radiographs to identify anterior osteophytes and assess cervical curvature 2
• CT cervical spine provides superior visualization of osteophyte size and anterior projection 5, 3
• MRI cervical spine evaluates disc protrusion, soft tissue changes, and excludes cord compression 3

Step 2: Swallowing Function Studies

• Modified barium swallow (videofluoroscopy) is the gold standard to document mechanical obstruction and assess swallowing phases 5, 7
• Esophagography can demonstrate esophageal compression by anterior vertebral osteophytes 3
• Fiberoptic endoscopic evaluation of swallowing (FEES) provides direct visualization 5

Step 3: Exclude Alternative Causes

The ACR dysphagia guidelines emphasize that multiple conditions cause dysphagia 5:

• Neurological disorders (stroke, Parkinson's disease, multiple sclerosis) 5
• Esophageal pathology (strictures, malignancy, motility disorders)
• Diffuse idiopathic skeletal hyperostosis (DISH) - a distinct entity from simple degenerative disease 8, 3

Treatment Approach

Conservative Management First-Line

For cervicogenic dysphagia from C5-C6 degeneration 1, 2:

• Texture-modified diet (soft, semisolid consistencies) as recommended by ESPEN guidelines 5
• Physical therapy and manual therapy targeting cervical mobility and muscle function 1
• Postural techniques including chin tuck and head rotation to facilitate swallowing 7
• Anti-inflammatory medications to reduce soft tissue swelling 1

Surgical Intervention Indications

Surgery should be considered when 8, 3:

• Conservative treatment fails after 3-6 months
• Significant weight loss or malnutrition develops despite dietary modifications
• Large anterior osteophytes clearly compress the esophagus on imaging
• Progressive symptoms with documented mechanical obstruction

Surgical approach involves anterior cervical osteophyte removal with or without discectomy/fusion depending on disc pathology 8, 3. The presence of an otolaryngologist during surgery is recommended given proximity to pharyngeal structures 8.

Common Pitfalls to Avoid

Do not assume all dysphagia in patients with cervical degenerative disease is cervicogenic - the ACR guidelines note that degenerative changes are extremely common in asymptomatic individuals over 30 years 5. Systematic screening for neurological causes is mandatory, particularly in elderly patients where stroke, Parkinson's disease, or other neurodegenerative conditions are more prevalent 5, 1.

Do not overlook DISH as a distinct entity - this condition produces more extensive anterior osteophytes than typical degenerative disease and has specific surgical considerations 8, 3.

Correlation between imaging findings and symptoms is essential - anterior osteophytes must be of sufficient size and location to mechanically compress swallowing structures 4, 3.