Cervicogenic dysphagia is difficulty swallowing (dysphagia) that originates from structural or functional issues within the cervical spine, or neck. This condition is distinct from swallowing problems caused by neurological disorders or direct pathology of the esophagus. Common causes involve degenerative changes in the cervical vertebrae, such as bony growths called osteophytes, or changes in the neck’s natural curvature. Trauma, spinal instability, and conditions like Diffuse Idiopathic Skeletal Hyperostosis (DISH), where ligaments calcify, can also lead to this issue by mechanically impeding the pharynx or esophagus. Because difficulty swallowing poses a risk to nutrition and pulmonary health, a precise diagnosis is necessary before initiating treatment.
Initial Management and The Specialist Team
Addressing cervicogenic dysphagia requires a coordinated effort from multiple healthcare professionals. Management begins with a thorough diagnostic workup, often led by otolaryngologists or gastroenterologists, to confirm the cervical origin and exclude other causes of dysphagia. These specialists perform initial assessments to check for masses or inflammation in the throat and upper digestive tract.
The Speech-Language Pathologist (SLP) plays a central role by conducting instrumental assessments of swallowing function. Tests like a Modified Barium Swallow Study (MBSS) or a Fiberoptic Endoscopic Evaluation of Swallowing (FEES) visualize the swallowing process to identify specific impairments, such as reduced laryngeal elevation or pharyngeal residue. This information informs the therapy plan. Physical Therapists (PTs) or chiropractors evaluate the underlying cervical mechanics, assessing for poor posture, limited range of motion, and muscle tension that contribute to the problem.
Targeted Swallowing and Physical Therapies
Conservative management through specialized therapies focuses on both the swallowing muscles and the neck mechanics. The Speech-Language Pathologist guides patients through targeted swallowing exercises to improve muscle strength and coordination. Compensatory strategies, such as the effortful swallow, help increase tongue base retraction and pharyngeal pressure to clear food more effectively.
Strengthening exercises are employed, including modifications of the Shaker exercise, which aims to increase the opening of the upper esophageal sphincter by strengthening the suprahyoid muscles. Other techniques involve specific head turns or chin tucks during the swallow to redirect the food bolus past the area of impingement or improve airway protection. These exercises aim for long-term physiological improvement.
The Physical Therapist focuses on correcting the underlying cervical spine dysfunction causing impingement or neural irritation. Treatment includes manual therapy techniques, such as mobilization and gentle manipulation, to restore proper joint mechanics in the neck. Exercises are prescribed to improve neck posture, strengthen the deep cervical flexors, and increase cervical range of motion. Postural modification during meals is also an effective strategy, as maintaining an optimal head and neck position can immediately reduce mechanical compression on the esophagus.
Pharmacological and Interventional Pain Management
Pharmacological interventions are necessary when pain, inflammation, or muscle spasm from the cervical spine interferes with swallowing or participation in physical therapy. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used to reduce inflammation and swelling around the cervical vertebrae and soft tissues. This reduction can decrease pressure or irritation on the pharynx and esophagus.
Muscle relaxants are also frequently prescribed to manage the muscle spasms that can occur in the neck due to underlying spinal issues, which can further constrict the area around the swallowing tract. For nerve-related pain or chronic discomfort, medications that target nerve pain pathways may be utilized to improve comfort and facilitate better movement. The goal of this pharmacological approach is to manage the pain source, making it easier for the patient to engage in active rehabilitation.
Interventional Procedures
For localized, severe pain unresponsive to oral medications, interventional procedures offer targeted relief. These interventions often involve injections, such as cervical nerve blocks or facet joint injections, which deliver a corticosteroid and anesthetic mixture directly to the source of pain and inflammation in the spine. Trigger point injections may also be used to release muscle knots in the neck and upper back contributing to tension and altered mechanics. These injections are considered a third-line treatment, aiming to break the cycle of pain and spasm so the patient can progress with therapy.
Surgical Solutions for Anatomical Impingement
Surgical intervention is typically reserved for cases where conservative management fails to provide adequate relief or when a large, anatomical defect is the clear and unyielding cause of the dysphagia. Primary structural problems necessitating surgery include very large anterior cervical osteophytes (bony spurs) or severe spinal deformity that mechanically obstructs the pharynx or esophagus. Diffuse Idiopathic Skeletal Hyperostosis (DISH) frequently leads to large calcifications requiring surgical removal.
The most common surgical approach is an osteophytectomy, which involves removing the bony spurs compressing the swallowing structures. This procedure is often performed via an anterolateral approach to access the front of the cervical spine. If underlying spinal instability or severe deformity exists, the procedure may be combined with a spinal fusion to stabilize the affected vertebrae, preventing future movement or impingement. Surgery is considered a last resort due to the risks and recovery time, but it can provide significant improvement in swallowing function when a substantial physical obstruction is present.