Potential Causes for Dysphagia

Difficulty swallowing, known as dysphagia, has dozens of potential underlying causes, ranging from pervious cervical spine surgeries to natural aging. These potential causes, as well as commonly used treatments, are described below.

Previous Cervical Spine Surgeries

Dysphagia can result from cervical spine surgeries that require an incision at the front of the neck, including:

• Artificial cervical disc replacement, which replaces a damaged disc between two vertebrae in the neck with an artificial disc.

  See Cervical Artificial Disc Replacement Surgery

• Anterior cervical discectomy and fusion (ACDF), which removes some or all of a damaged cervical disc and replaces it with a bone graft, so that the two adjacent vertebrae eventually fuse together.

  See After ACDF: Trouble with Swallowing

People who have these surgeries may have trouble swallowing for one or more reasons, including:

• Post-surgical swelling
• Prominence of the metal plate (in the case of fusion) or implant (in the case of a problem with the disc replacement, e.g. the implanted disc becomes dislodged)
• A soft-tissue injury resulting from the retraction of the esophagus during surgery
• Decreased mobility in the cervical spine

• Anterior cervical spine bone spurs; these bony abnormalities are also called osteophytes

  See Cervical Osteophytes: Bone Spurs in the Neck

Post-surgical dysphagia is typically not permanent. For example, one study found that 71% of fusion patients reported trouble swallowing 2 weeks after surgery, but that number lowered to 8% twelve weeks after surgery.¹Rihn JA, Kane J, Albert TJ, Vaccaro AR, Hilibrand AS. What Is the Incidence and Severity of Dysphagia After Anterior Cervical Surgery? Clinical Orthopaedics and Related Research. 2011;469(3):658-665. doi:10.1007/s11999-010-1731-8.

People who have undergone multiple cervical spine surgeries, people who had multi-level surgeries (i.e. 3 or more vertebrae involved), and women seem to be at an increased risk for long-term dysphagia after anterior (front of the neck) cervical spine surgery.

Abnormal Growths

Sometimes an abnormal growth can press on the throat or esophagus and hinder the ability to swallow.

• Bone spurs (osteophytes) on the spine can result from conditions such as:
  • Diffuse idiopathic skeletal hyperostosis, often called DISH or Forestier’s disease, a degenerative form of arthritis characterized by excessive growth of the bones along the sides of the vertebrae and spine.
  • Ankylosing spondylitis
  • Osteoarthritis of the spine
  • A trauma to the spine
  • Metabolic imbalances and hormone disorders, such as acromegaly, that facilitate abnormal bone growth
• Cancers of the cervical spine and esophagus can result in tumors that put pressure on people’s throats and/or esophogi.

A doctor may recommend surgery to remove the bone spur or tumor, depending on the patient and circumstances.

Other Potential Causes of Dysphagia

In addition to previous surgeries and abnormal growths, there are many other causes of dysphagia, including:

• Neurological problems, such as Alzheimer’s disease, Parkinson’s disease, stroke, and spinal cord injuries.
• Musculoskeletal conditions, such as systemic scleroderma (sclerosis), spinal muscular atrophy, and (rarely) cervical osteophytes due to osteoarthritis.
• Cancer treatments, including radiation and chemotherapy.
• Metabolic disorders that cause muscle weakness in the throat or esophagus, such as thyroid disorders.
• Gastroesophageal reflux disease (GERD), which can cause esophageal spasms or scarring and make swallowing difficult.
• Foreign bodies or food lodged in the throat or esophagus. In addition, people who have a condition called pharyngeal diverticula develop a small pouch in the throat that can fill up with food particles, making it hard to swallow.
• Changes related to old age and other conditions, such as severe respiratory issues.

Many of these conditions lead to the stiffening or weakening of the esophagus, the muscular tube involved in swallowing.