[Cervicogenic dysphagia: swallowing difficulties caused by functional and organic disorders of the cervical spine]

Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia; CD) are: chronic multisegmental/MS dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes, anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis, injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors. According to our clinical observations, degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints are disorders which can cause swallowing difficulties. However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in differential diagnosis. Because of the close anatomical relationship of cervical spine with the pharynx and cervical part of esophagus, the consequences of the degenerative changes in the cervical discs and facet joints and chronic MS dysfunction of the cervical spine facet joints such as the changes in the physiological curvature of the cervical spine, changes in elasticity and contractility in the neck muscles and decreased mobility of the cervical spine, adversely affect the dimensions of the pharynx and cervical part of esophagus, that is, swallowing capacity which can result in dysphagia. Degenerative changes in the cervical discs and facet joints are common additional cause of dysphagia in elderly people with disorders of the central control of swallowing (stroke, Parkinson's disease, senile dementia etc). The most important therapeutic options in patients with CD are: medicamentous therapy, physical therapy, manual therapy, kinesiotherapy and surgical treatment. The aim of the conservative therapy in patients with CD is to improve the swallowing capacity (for example, soft tissue techniques, stretching of the shortened muscles, passive and active mobilization of the facet joints). As the patients with CD usually respond well to the appropriate therapy, cervical causes of dysphagia cannot be overlooked in patients with difficulty swallowing, including patients with disorders of the central control of swallowing.