Cervical disc disease and difficulty swallowing – cervicogenic dysphagia
Ross A. Hauser, MD.
Treating Cervical Spine Instability is treating swallowing difficulties
- In this article, we will discuss the problems of swallowing difficulties as they relate to the diagnosis of cervical spine disorder or cervical instability caused by weakened, torn, damaged ligaments in the neck.
- Cervical instability in the neck has been linked to swallowing difficulties, diagnosed as cervicogenic dysphagia.
- Cervical instability has been linked to cervical spine nerve compression which can be an “unseen” cause of swallowing difficulties, esophageal spasms, and acid reflux.
- Cervicogenic dysphagia is not a problem that can be treated in isolation, it is likely one of a myriad of symptoms related to neck pain and neck hypermobility.
When a patient comes into our clinic with problems of swallowing difficulties, the swallowing difficulties are usually not a problem in isolation. The patient will describe a medical history as an injury, car accident, or degenerative bulging discs in the neck. Sometimes they will describe that swallowing difficulties, as well as other strange symptoms, came upon them suddenly and for “no reason.”
Sometimes we will hear a medical history that the person themselves call “bizarre” and further describe themselves as a “medical mystery.” People will describe the onset of symptoms that just happened “out of nowhere.”
When a patient comes into our clinic with problems of swallowing difficulties, the swallowing difficulties are usually not a problem in isolation. While patients may tell us of their swallowing difficulties, most come in with primary complaints of neck pain or neck instability, whiplash-associated disorders, or post-concussion syndrome. Swallowing difficulties may be accompanied by headaches, dizziness, hearing problems, severe muscle spasms in the neck, ear filling, and skipped names but just a few symptoms.
In this article, we will present research, clinical observation, and patient outcomes to suggest that treating instability in the cervical spine with regenerative proliferative injections can help many patients with swallowing difficulties.
Discussion summary points:
- Treating Cervical Spine Instability is treating swallowing difficulties.
- A link between cervical spine instability to swallowing difficulties used to be rarely acknowledged and for the most part ignored.
- It was clear that the patient’s swallowing difficulties were coming from the cervical spine.
- Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.
- C2 malrotation can cause swallowing difficulties.
- Even though I have neck problems I was sent for an endoscopy – Esophagogastroduodenoscopy
- “If she held her head still, she was able to swallow”
- Swallowing difficulties and bone spurs
- Searching for clues when surgery and treatment fail to correct swallowing difficulties.
- Swallowing difficulties and Diffuse idiopathic skeletal hyperostosis – “an underappreciated phenomenon”
- Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments.
- Swallowing difficulties: A problem of autonomic nervous system dysfunction?
- Swallowing difficulties: A problem of age?
- Swallowing difficulties: A problem of posture?
- Swallowing difficulties are caused by the odontoid process of the axis because of C1/2 instability.
- Swallowing difficulties: TMJ Involvement with cervical instability.
- There is no doubt that TMJ patients suffer from swallowing difficulties, but do they have cervical instability as well, and is this making swallowing more challenging?
- There is a problem with the chewing muscles contributing to problems in your cervical spine and your entire posture.
- Does surgery cause swallowing difficulties?
- Treating Cervical Spine Instability is treating swallowing difficulties.
- We will see many patients who were told about surgeries.
- Brain fog, breathing and swallowing difficulty, dizziness, tinnitus.
- Research on cervical instability and Prolotherapy.
A link between cervical spine instability to swallowing difficulties used to be rarely acknowledged and for the most part ignored.
The caption reads The three phases of swallowing. The vagus nerve is involved in all three phases of swallowing as it innervates most of the pharynx and larynx mucosal surfaces as well as the muscle that elevates the palate and causes the larynx to contract. As we will discuss below, compression or interruption of the vagus nerve signals caused by neck instability can lead to swallowing difficulties.
Swallowing is a complex process involving the coordinated interactions of a network of nerves and muscles. The muscles of the mouth, back of the throat (pharynx), and the top end of the esophagus (upper esophageal sphincter) are directly connected to the brain through the cranial nerves, including the vagus nerve, and can be affected by many neurological disorders.
In 2013, noted Croatian musculoskeletal researcher Vjekoslav Grgić published a paper linking cervical spine instability to swallowing difficulties. (1) He also noted that this association was rarely acknowledged and for the most part ignored. We are going to present research below that takes us to 2023 and see how much has changed in 10 years. Surprisingly, it will be not much.
Here is Dr. Grgić’s review summary. See if this sounds familiar to your own case:
“Cervical spine disorders which can cause swallowing difficulties (cervicogenic dysphagia) are chronic multisegmental/musculoskeletal dysfunction (dysfunction=functional blockade) of the facet joints, changes in physiological curvature of the cervical spine, degenerative changes (anterior osteophytes (bone spurs), anterior disc herniation, osteochondrosis, osteoarthritis), inflammatory rheumatic diseases, diffuse idiopathic skeletal hyperostosis (extensive amount of calcification that occurs within the spinal ligaments in the condition), injuries, conditions after anterior cervical spine surgery, congenital malformations and tumors.
According to our clinical observations, degenerative changes in the cervical discs and cervical facet joints and chronic musculoskeletal dysfunction of the cervical spine facet joints are disorders that can cause swallowing difficulties.
However, these disorders have not been recognized enough as the causes of dysphagia and they are not even mentioned in the differential diagnosis.“
It was clear that the patient’s swallowing difficulties were coming from the cervical spine
In this case review from the New York Chiropractic & Physiotherapy Centre, reported in the Clinical Medicine Insights. Case Reports, (2) the doctors acknowledged that when someone has swallowing difficulties this could be “salivary secretory disorders, poor oral motor coordination, neuromuscular weakness, neurodegenerative diseases, stroke, and structural changes, can result in swallowing disorders.” But here they presented a case that they found astounding enough to publish the results. What made this case so astounding? It was clear that the patient’s swallowing difficulties were coming from the cervical spine.
Listen to the case:
- An elderly woman with upper neck stiffness and dysphagia sought chiropractic treatment.
- Her radiographic findings suggested cervical spondylosis with a vertical atlantoaxial subluxation (C1-C2 instability causing unnatural movement in the vertebrae).
- Following 20 sessions of chiropractic treatment, the patient experienced complete relief from neck problems and difficulty in swallowing.
How did this happen?
- In this case, the brain stem could have been compressed by the odontoid process of the axis due to C1/2 instability.
The conclusion of all this?
- Cervicogenic dysphagia is a cervical cause of difficulty in swallowing.
- Cervical complaints in the context of dysphagia are mostly underestimated.
Cervicogenic dysphagia caused by cervical spine/neck instability is not underestimated. In this case, chiropractic care was able to help eliminate the swallowing difficulties. As we will discuss below in our office we will employ cervical curve correction techniques as well as Prolotherapy injections to provide strength and stability to the spinal ligaments and the supportive structures of the neck.
Ross Hauser, MD discusses C2 Malrotation and the symptoms associated with it, as well as why we like adjustments, curve correction, and Prolotherapy to help restore spinal integrity and resolve symptoms.
Video learning points:
The malrotation of the C2 vertebrae or the axis, is often what I call the the Missing Link into what is causing a person’s symptoms.
- Rotated C2 can compress the vagus nerve that can cause digestive problems seen in some upper cervical instability patients.
- Rotated C2 can cause compression on the glossopharyngeal nerve which can cause dysfunction of the larynx muscles and cause swallowing difficulties.
- Rotated C2 can cause compression of the spinal accessory nerve cause cramping into the sternocleidomastoid muscle or the trapezius muscle and creating a situation of torticollis.
- Rotated C2 can cause compression and obstruct right jugular vein causing increased brain pressure and problems of cognitive decline and mood disorders.
- Rotated C2 can compress the carotid sheath causing compression on jugular veins and carotid arteries causing intracranial hypertension.
Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.
In September 2021, the same doctors presented another case in the Journal of Family Medicine and Primary Care. (15) Here doctors described a “unique case.”
“Dysphagia (swallowing difficulty) is most often related to other health problems, including brain or spinal cord injury, neurological damage, neuromuscular disorders, and anatomical conditions. Dysphagia can have detrimental effects on pulmonary health and also impact nutritional intake. The right treatment depends on the cause established. Cervicogenic dysphagia is a cervical cause of difficulty in swallowing. This report describes a 53-year-old female patient with a sore throat, swallowing difficulty for solids, and acid reflux for 2 years. Radiographs revealed anterior osteophytic lipping (abnormal boney growth or spurs on the vertebrae) and kyphosis of the cervical spine and thoracolumbar (right convex) scoliosis. After 6 months of chiropractic treatment, her complaints and spinal deformity were obviously resolved. Correction of spinal deformity could result in positive treatment outcomes in selected patients with symptoms of cervicogenic dysphagia.”
C2 malrotation can cause swallowing difficulties
In this x-ray from one of our patients, we can display C2 malrotation. The dotted center line represents where the center of the C2 should be. We see that the C2 is shifted far over. Restoring the C2 to its natural position can alleviate swallowing difficulties as well as many symptoms attributed to cervical spine instability.
Next is a video from Ross Hauser, MD., where cervical spine instability is associated with cervical nerve dysfunction.
In this video Ross Hauser, MD explains the functional dynamics and possible solutions to swallowing difficulties.
Video Summary Transcript
Swallowing involves many of the cranial nerves: The image below focuses on the epiglottis (the skin flap that helps prevent choking) moves to cover it.
- Cranial Nerve V or the trigeminal nerve, involves the muscles of biting, chewing, and swallowing
- Cranial Nerve VII or the facial nerve which in addition to assisting in swallowing is involved with taste sensation and salivary glands
- Cranial Nerve X or the Vagus Nerve
- The Vagus nerve plays a vital role in the pharyngeal phase of swallowing. This is what happens during this phase:
- The vocal cords close the larynx to help keep food and liquids from entering the airway and lungs. As the larynx closes, the epiglottis (the skin flap that helps prevent choking) moves to cover it.
- Patients with swallowing difficulties caused by a disruption in the pharyngeal phase may suffer from:
- Coughing during swallowing
- Breathing difficulties during swallowing
- A choking sensation
- A change in voice during swallowing
- More severe cases may include food particles passing into the lungs and causing pneumonia-like symptoms or pneumonia itself.
- The Vagus nerve plays a vital role in the pharyngeal phase of swallowing. This is what happens during this phase:
- Cranial Nerve IX or glossopharyngeal nerve which moves muscles of the tongue and throat
- Cranial Nerve XII or the hypoglossal nerve controls muscles in the pharynx (throat) and helps move found out of the mouth to the esophagus.
All these nerves run around the front of the cervical spine’s vertebrae, especially at C1 – C2. When somebody does have cervical instability it’s normally because of excessive stretching of the ligaments in the back of the neck. When these ligaments are weak, injured, or torn what happens is the cervical vertebrae move forward when they move forward they can impair the nerve’s impulse through these various nerves. More symptoms such as choking on excretions, spit, or mucus can occur. Difficulty in talking may occur as if your muscles are too weak to talk.
Difficulty swallowing, the inability to breathe properly, and changes in voice are among the most distressing symptoms a person can have. If normal imaging scans and videoscopes do not find any obvious structural cause, then, the “ground zero” of cause should suspect and focus on vagus nerve injury and cervical spine instability
This article is a companion work to these articles on our website: Please see
- Vagus nerve compression in the neck: Symptoms and treatments
- Hiccups, Cough, Neck Pain, and Vagus and Phrenic Nerve Injury
In our office, we use injection techniques like Prolotherapy to help stabilize the cervical spine. In many patients, we can reverse these symptoms by stabilizing the cervical spine and restoring the neck’s natural curve. This is explained below.
Even though I have neck problems I was sent for an endoscopy – Esophagogastroduodenoscopy
Often we will hear a story, it goes something like this:
I have had chronic problems with my neck. One of my problems is that, over time, I have found it more difficult to swallow foods. I was sent for an endoscopy to rule out digestive problems, I have already had enough x-rays and MRI to rule out cancer. I know the swallowing difficulty is from my neck problems. My diet over the last few months has increasingly become a steady menu of soups and broths. I feel something is stuck in my throat, I belch a lot, and I get anxious about eating for fear of choking on my food. I also find that many times when I try to swallow I feel like I am going to faint or pass out.
My endoscopy was inconclusive
“If she held her head still, she was able to swallow”
Swallowing difficulties and bone spurs
There is not much research in the medical community that focuses solely on swallowing difficulties in relation to cervical spine instability. But there are many clues that clearly make a connection.
In the April 2017 issue of the Journal of Bodywork and Movement Therapies, a combined team of researchers from the University of Padova and the University of Bologna in Italy documented the case history of a young female patient with swallowing difficulties. (3)
- The patient complained of pain in the neck and swallowing dysfunction that was reduced by means of isometric contraction of cervical muscles. Isometric contraction is a routine exercise where the muscle and joints are held in a static position.
- In other words, the patient was able to find a position where if she held her head still she was able to swallow. If she stabilized her neck, she could swallow.
In this case study, the doctors performed an MRI that revealed an anterior C5-C6 disc protrusion associated with a lesion of the anterior longitudinal ligament. The barium radiograph showed a small anterior cervical osteophyte (bone spur) at the C6 level.
Conclusion: Diagnostic hypothesis was a combination of cervical disc dysfunction associated with C6 osteophyte and reduced functional stability AND a ligament tear.
- So we have a clue, ligament tears, and cervical neck instability cause swallowing difficulty. If you stabilize the neck, you can swallow.
Searching for clues when surgery and treatment fail to correct swallowing difficulties.
We have seen many patients with degenerative cervical spinal disease who can no longer tolerate continued high dosage narcotic painkillers or the anxiety or depression trip after trip to specialist after specialist is causing them. One clue that we may be able to help these people with their challenges including swallowing difficulties is if you put them in a cervical collar, do they get relief? If the answer is yes, then the collar is providing the missing cervical neck instability.
We do see people with advanced degenerative cervical disc disease who have or had significant bone spur formation. Many of these patients have had surgery to remove the bone spurs, yet their swallowing difficulties remained. If it was not the bone spurs pressing on the esophagus, what could it be? Why do these people still have swallowing difficulties after surgery?
Swallowing difficulties and Diffuse idiopathic skeletal hyperostosis – “an underappreciated phenomenon”
Similarly, Cervicogenic dysphagia can be brought on by diffuse idiopathic skeletal hyperostosis, (DISH) a condition where the cervical ligaments and their attachments to the vertebrae (the entheses) undergo calcification and ossification. In general terms, the soft tissue has calcified or turned into bone spurs. The bone spurs cause esophageal obstruction. Aging patients, men more so than women are susceptible to swallowing difficulties related to diffuse idiopathic skeletal hyperostosis.
Diffuse idiopathic skeletal hyperostosis is a more common disorder than some doctors thought. Doctors in the Netherlands issued this warning in The Spine Journal:
“Diffuse idiopathic skeletal hyperostosis as a cause of dysphagia and/or airway obstruction may be an increasing and underappreciated phenomenon.”(4)
Diffuse idiopathic skeletal hyperostosis can be brought on by degenerative wear and tear, as mentioned above, as a result of age or overuse. As with any bone spur, bone spurs form to help stabilize a joint. Diffuse idiopathic skeletal hyperostosis develops to stabilize cervical instability by turning the soft tissue attachments that are failing, into bony attachments. This, unfortunately, distorts the cervical spine and leads to various cervical-related symptoms beyond swallowing difficulties.
- Another clue linking the cervical ligaments to swallowing difficulties.
Let’s look at this further
Diffuse idiopathic skeletal hyperostosis, bone spurs, and cervical spine surgery
An August 2021 study from the University of Iowa Hospitals and Clinics looked at outcomes and complications of surgical treatment of anterior osteophytes (bone spurs at the front of the cervical spine) causing dysphagia to “better understand the functional swallow outcomes, cervical balance, and surgical complications.” The research was published in the journal Clinical Neurology and Neurosurgery. (8)
The researchers wrote that bone spurs from diffuse idiopathic skeletal hyperostosis (DISH) or degenerative disc disease of the cervical spine can cause dysphagia from mechanical compression of the esophagus. “Osteophytectomy is generally accepted as a safe surgical treatment, but the risk of instability is unclear. The potential for associated complications (that is cervical instability) must be considered.”
In this study of 15 surgically treated patients, there was a 27% complication rate including a case of C5 lateral mass fracture with central cord syndrome after a fall four days following osteophytectomy. There was one patient who was preoperatively dependent on a gastrostomy tube required a tracheostomy and had continued reliance on the gastrostomy tube.
The researchers concluded that surgical treatment of anterior osteophytes causing dysphagia with osteophytectomy can lead to overall improvement for most patients, however, a high preoperative (difficulty swallowing) FOSS (Functional outcome swallowing score) score may be a prognostic indicator of poor postoperative functional swallow outcome. The researchers added: “It is important to consider the potential for instability when osteophytectomy is performed at 3 or more spinal segments.”
Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments
Now let’s explore a March 2019 study in the medical journal Spine. (5) This research comes from the Department of Orthopaedic Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Japan. the goal of this study was to investigate whether cervical (neck) alignment is related to dysphagia in patients with cervical diffuse idiopathic skeletal hyperostosis.
This is what the researchers found puzzling:
- Diffuse idiopathic skeletal hyperostosis involves a wide range of ligamentous ossifications (calcifying of the ligament), which can cause dysphagia. However, even patients with a high degree of ossification can have only mild dysphagia. Dysphagia results from esophageal compression due to ossification; however, the exact cause of dysphagia is unknown.
So they looked at 5 patients with advanced dysphagia due to anterior cervical hyperostosis (bone spurs) who underwent bone removal, and five patients with mild symptoms who were only monitored.
- The Eating Assessment Tool-10 (EAT-10) (most of you are aware this is a swallowing evaluation measurement) indicated a high degree of dysphagia in the people who had surgery for bone removal compared with the non-surgical group.
- In the surgery group, the EAT-10 score significantly decreased postoperatively and improvement in dysphagia was observed.
- The conclusion was: “restriction of flexion due to cervical spine ankylosis may be one of the reasons for dysphagia in patients with DISH.”
What is this research telling us?
- Swallowing difficulties can be a degenerative disorder of weakened cervical neck ligaments
- Weakened cervical neck ligaments cause neck instability
- Neck instability causes abnormal motion in the cervical vertebrae
- Abnormal motion causes bone spurs
- Bone spurs cause swallowing difficulties.
Swallowing difficulties: A problem of autonomic nervous system dysfunction?
Swallowing difficulty may also be due to autonomic nervous system dysfunction that may be caused by Barré-Lieou Syndrome, also known as a posterior cervical sympathetic syndrome and cervicocranial syndrome. This can be a severely debilitating condition in which the autonomic nervous system of the head and neck area is not working correctly. In almost all patients we see, there is a link between cervical spine instability and the onset of Barré-Lieou Syndrome.
Swallowing is a very complex process that involves the mouth, throat, and esophagus. Many nerves and muscles affect the correct functioning of these parts, and while part of the process of swallowing is under voluntary control, much of it is involuntary. Cervical spine instability can affect both voluntary and involuntary responses.
- Another clue linking the cervical ligaments to swallowing difficulties.
Swallowing difficulties: A problem of glossopharyngeal and vagus nerve dysfunction?
Glossopharyngeal and vagus nerve dysfunction are typically the cause of chronic swallowing problems when the person has seen a myriad of clinics without a plausible answer to their symptoms. The glossopharyngeal innervates the stylopharyngeus muscle which elevates the larynx and pulls it forward during the pharyngeal stage of the swallow. This action also aids in the relaxation and opening of the cricopharyngeus muscles. It along with the vagus nerve provides the innervation to the upper pharyngeal constrictor muscles. The glossopharyngeal nerve also mediates all sensation, including taste, from the posterior 1/3 of the tongue (the facial nerve is responsible for the anterior 2/3 of the tongue).
Swallowing difficulties: A problem of age?
The muscles and support structures of the neck make for good swallowing function. As we age degenerative disease can affect the muscles, tendons, and ligaments that help us swallow.
A study in the journal Current Opinion in Otolaryngology & Head and Neck Surgery (6) suggests that surgeons and clinicians explore multidisciplinary perspectives and initiatives, (it is not just one thing causing the problem and you may need to explore “innovative” and multiple treatments).
One thing that the researchers suggest as innovative is swallowing exercises. This is to build up the muscular structure of the swallowing mechanism. To build up muscle you need strong tendons and ligaments. You have to deal with the problem of cervical instability.
- Another clue linking the cervical ligaments to swallowing difficulties. It should be clear at this point that there is a link. The next step is how cervical instability affects posture.
Swallowing difficulties: A problem of posture?
In the medical journal Dysphagia, (7) researchers discussed the relationship between oropharyngeal (back of the throat) dysphagia and its relationship to cervical spine disorders and postural disturbances due to either congenital or acquired disorders.
They write: “The etiology and diagnosis of dysphagia are analyzed, focusing on cervical spine pathology associated with dysphagia as severe cervical spine disorders and postural disturbances largely have been held accountable for deglutition (swallowing) disorders.”
- and osteophytes are the primary focus in finding the link between cervical spine disorders and dysphagia.
“It is important for physicians to be knowledgeable about what triggers oropharyngeal dysphagia in cases of the cervical spine and postural disorders. Moreover, the optimum treatment for dysphagia, including the use of therapeutic maneuvers during deglutition, neck exercises, and surgical treatment, (should be discussed with patients).”
This is an email we received, it has been edited for clarity and continuity. It is not a unique type email. It is among the many we get describing the similar challenges that many people get.
My primary medical concerns are severe dysphagia (swallowing difficulties) which has resulted in a percutaneous endoscopic gastrostomy PEG feeding tube being placed in my stomach. I have been diagnosed with a military Neck (no neck curvature).
Over two years ago I began having difficulty swallowing larger vitamins; however, I was still able to eat and drink without difficulty. More recently I fell and fractured the radial head in my left elbow and hit the side of my head (no concussion). Less than two months later, a cluster of symptoms began which I do not know if they have anything to do with this fall. I had the onset of symptoms- ear ringing/pain, chronic vertigo, chronic nausea- (I had to take Zofran daily for 6+ months) with onset severe dysphagia. I was only able to eat a few jars of baby food, protein drinks, and popsicles.
Later, due to the increasing severity of the ear pain, I went to the ER and subsequently was seen by three different ENT specialists. I also was seen at an Urgent Care. All said my ears looked normal. One of the ENTs ordered an MRI of brain which was normal and I also had hearing test which came back normal. I was referred to a Gastroenterologist. I had a full GI workup: upper endoscopy, barium swallow, gastric empty study, and modified barium swallow. Two months later I had a modified barium swallow which was abnormal.
Due to the dysphagia and other symptoms, I was referred to a neurologist. I developed the onset of left tongue deviation off and on for months which impacted the dysphagia more. Neurologist ordered lab work and I was negative for myasthenia gravis. A second brain MRI showed 3 mm cellebellar tonsillar ectopia. (Chiari 1 malformation) I then was referred to a Neurosurgeon.
Due to what the surgeon believed to be Chiari symptoms (chronic pressure in back of head, ear ringing, difficulty swallowing, vertigo, blurred vision, tingling in hands in feet, and tongue deviation.) It was decided to do Chiari decompression surgery. My doctor said the surgery would most likely resolve my other symptoms, but due to the severity of dysphagia, he was not sure if surgery would resolve my swallowing difficulties.
I had a Suboccipital craniotomy with C1 laminectomy. Since surgery, the pressure in back of head, ear ringing, vertigo, blurred vision, etc. have improved. The swallowing has not. A few months after surgery, my tongue started to deviate to the left again- which it hadn’t for months. I followed up with my neurologist and he does not feel the dysphagia is neurological. I had extensive blood work everything was normal, I had a CT of my neck, I have no curvature in my neck, I had the military neck. I have both Oropharyngeal dysphagia and I feel esophageal dysphagia. When the dysphagia began, I had to order pureed food and was only getting down 400-600 calories a day. The dysphagia has been progressive. After seeing the CT images of my neck- I feel that I have cerviogenic dysphagia. the longer my head is upright, my neck muscles become fatigued which also affects my swallowing. I cannot hold my neck up very long due to severe neck pain.
Swallowing difficulties: TMJ Involvement with cervical instability
In the Journal of Oral and Maxillofacial Surgery: The Official Journal of the American Association of Oral and Maxillofacial Surgeons, (9) doctors looked at oral stage dysphagia (swallowing difficulties that begin in the mouth) with potential effects on function and patient well-being.
To examine the effects of function in TMJ patients, the doctors looked at 178 TMJ/TMD temporomandibular joint dysfunction patients.
- Of the 178 TMD participants, 99% reported at least one symptom or sign of oral-stage dysphagia.
- Individuals presenting with
- subluxation of the jaw (80%),
- degenerative joint disorder (67%),
- and myofascial pain disorder (40%) reported oral-stage dysphagia most frequently.
There is no doubt that TMJ patients suffer from swallowing difficulties, but do they have cervical instability as well, and is this making swallowing more challenging?
In many patients, we see primary problems related to neck pain and cervical instability see problems of TMJ. In many patients that we see with problems of TMJ, we see cervical neck pain. Surprisingly, despite the research suggesting the connection, many patients were not made aware that their jaw pain could be a problem originating in the neck.
In the medical journal Clinical Oral Investigations, (10) oral surgeons in Belgium made a connection.
They conducted a study looking for possible correlations between clinical signs of temporomandibular disorders (TMD) and cervical spine disorders.
- Thirty-one consecutive patients with symptoms of TMD and 30 controls underwent a standardized clinical examination of the masticatory system, evaluating the range of motion of the mandible, temporomandibular joint (TMJ) function, and pain of the TMJ and masticatory muscles.
- Afterward, subjects were referred for clinical examination of the cervical spine, evaluating segmental limitations, tender points upon palpation of the muscles, hyperalgesia, and hypermobility.
- The results indicated that segmental limitations (especially at the C0-C3 levels) and tender points (especially in the sternocleidomastoideus and trapezius muscles) are significantly more present in patients with TMJ than in the control subjects
There is a problem with the chewing muscles contributing to problems in your cervical spine and your entire posture
Swallowing difficulties are hard to manage because in some patient cases, possibly yours, you have to continuously “peel the onion,” to get to the true root cause of the patient’s problem. Swallowing difficulties may not be a primary complaint of a patient, but one of the many complaints that seemingly have no answer. Here we are examining whether the muscles of the jaw are negatively impacting your cervical spine and if your swallowing difficulties, indeed many problems you are suffering from, may be from this connection.
In the European Journal of Orthodontics, (11) doctors in Japan made a connection:
- In this study, the doctors compared the mandibular stress distribution and displacement of the cervical spine. In simple terms, how TMJ instability and hypermobility of the jaw negatively affected the cervical spine.
- What did they find? ” (an) imbalance between the right and left masticatory muscles antagonistically act on the displacement of the cervical spine, i.e. the morphological and functional characteristics in patients with mandibular lateral displacement may play a compensatory role in posture control.”
What? The TMJ altered your posture by stressing your cervical spine. Isn’t posture a problem of swallowing difficulties? Isn’t posture a problem of everything?
Surgery for swallowing difficulties – high risk – low reward?
When you look at the research above, especially when the bulk of it comes from oral and neurosurgeons, it is not difficult to see that surgery for swallowing difficulties is a high-risk – low-reward procedure. Let’s be clear though, there are times when surgery is necessary, especially if there is an anatomical deformity that is possibly life-threatening.
Now, what about the bone spurs?
Using exercise to help swallowing difficulties in cervical instability patients is clearly superior to surgery for patients desiring to avoid surgery. The problems of surgical correction of swallowing difficulties from bony overgrowth (osteophytes or bone spurs) are documented in this research by Turkish surgeons from the Gulhane Military Medical Academy and Gelibolu Military Hospital.
This study was presented in The Journal of Craniofacial Surgery (12) and discusses the advantages and disadvantages of anterior cervical osteophytes surgical procedures. (A frontal incision into the throat area or the mouth to get at the cervical bone spurs).
The doctors looked at the operative records of anterior cervical osteophyte patients who did not benefit from conventional treatments and underwent osteophytectomy (bone spur removal).
Five patients were operated on with the transcervical anterolateral method (incision into the neck), and 3 patients were operated on with the transoral procedure (through the mouth). Those using the transcervical method were likely to encounter complications. Although the transoral procedure is much safer, the patients may face postoperative pain, long healing times, and morbidities such as hematoma, cervical instability, and infection after surgery.
While both surgeries can improve swallowing difficulties, the price of complications and further instability in the future was warned about. The researchers did suggest that the Transoral approach is not recommended due to slow healing times and postoperative pain, although it creates easier access to the spine.
Does surgery cause swallowing difficulties?
In March 2019 in the journal Clinical Neurology and Neurosurgery, (13) researchers at the David Geffen School of Medicine and the Department of Neurosurgery at Kaiser Permanente discussed the reported incidence of dysphagia after Anterior Cervical Discectomy and Fusion. The researchers commented that up to 79% (4 out of 5 surgical patients) will suffer from swallowing difficulties.
Please see our article Anterior Cervical Discectomy and Fusion – The Evidence. Here we discuss the evidence that this surgery can cause more cervical spine instability and deformity
Returning to this study from March 2019, the researchers looked into what caused these problems of swallowing difficulties and further why it appears that doctors are not investigating this problem. The researchers noted: “There, however, have been no studies that have specifically looked at developing criteria for reducing the incidence of dysphagia for outpatient ACDFs.”
What caused the swallowing difficulties? The researchers found ONLY ONE THING:
- Single-level ACDF at the upper cervical spine (C2-3, C3-4) was found to be the only risk factor for dysphagia with a length of hospital stay of more than 48 hours.
- “These findings should be used for excluding patients who undergo outpatient single-level ACDF surgery to reduce significant postoperative dysphagia.”
Treating Cervical Spine Instability is treating swallowing difficulties
In this video, DMX imaging displays Prolotherapy results in before and after treatment images. This patient’s treatment had problems of a pinched nerve in the cervical spine resolved. Prolotherapy is discussed below. Prolotherapy is a regenerative medicine injection treatment that utilizes dextrose, a simple sugar as a proliferant to rebuild soft tissue structures.
This video demonstrates the alleviation of cervical disc herniation and the patient’s related symptoms.
- In this video, we are using a Digital Motion X-Ray (DMX) to illustrate a complete resolution of a pinched nerve in the neck and the accompanying symptoms of cervical radiculopathy.
- A before digital motion x-ray at 0:11
- At 0:18 the DMX reveals completely closed neural foramina and a partially closed neural foramina
- At 0:34 DMX three months later after this patient had received two Prolotherapy treatments
- At 0:46 the previously completely closed neural foramina are now opening more, releasing pressure on the nerve
- At 1:00 another DMX two months later and after this patient received four Prolotherapy treatments
- At 1:14 the previously completely closed neural foramina are now opening normally during motion
We will see many patients who were told about surgeries
We will see many patients who were told about surgeries, such as those spoken above, and offered surgical consultation for his/her problem with swallowing if there is a concern the problem is due to a diverticulum or outpouching of the throat. However, the surgical recommendation is often compromised by the difficulty in diagnosis.
Conservative treatments may be offered to see if the surgery is warranted or, better yet, avoided.
Recommendations to relieve the symptoms may include a bland diet, eliminating caffeine or alcohol from the diet, modifying the consistency of foods to make them easier to swallow, elevating the head while sleeping, or therapy to strengthen the swallowing muscles, particularly when the swallowing difficulty seems to be the result of neurological disorder. In certain situations drugs that slow the production of stomach acid, muscle relaxants or antacids may be prescribed.
However, the truth is, a person suffering from this often painful and debilitating condition may be seen by numerous specialists and yet find no resolution for the symptoms and, thus, no understanding as to why the condition exists at all.
In our office, we perform a physical examination and use our ultrasound and Digital Motion X-ray machine, described in the video above to get at the cause of the problem rather than simply seek to treat the symptoms. This helps us determine, if, as often, we are looking at a dysfunction of the autonomic nervous system, a problem of posture, a problem of degenerative aging, or a problem possibly of TMJ-related challenges.
Swallowing difficulties as well as a host of other symptoms including neck, eye, and facial pain, cervical vertigo, dizziness, and ringing in the ears, is very treatable using Prolotherapy to the neck ligaments.
Prolotherapy is, in our opinion, the safest and most effective non-surgical treatment for repairing ligament damage. It stimulates the body to repair damaged and weakened areas by inducing a mild inflammatory reaction. Since the body heals from inflammation, Prolotherapy stimulates healing.
As mentioned earlier, swallowing difficulty may also be due to an autonomic nervous system dysfunction. While the actual cause of this dysfunction may be elusive, Neural Therapy to the head and neck area has been known to help with swallowing difficulties. Neural therapy involves the injections of anesthetics to help the nerves reset themselves. For example, if the patient had previously had surgery in the mouth or neck area, the scars would be injected as they can act as “interference fields” to the autonomic nervous system.
Brain fog, breathing and swallowing difficulty, dizziness, tinnitus
Brad’s story will resonate with many of you. He will describe the same symptoms and combination of symptoms that many of our patients suffer with when they first see us.
Brad’s story is unique, it may not be typical of the patients we see. Brad with treated with Prolotherapy injections and neck curve correction techniques. Not everyone will achieve these results as the results of treatment will vary.
We specifically want to highlight his case because he has some unusual strange sensations in his ear and breathing difficulties because of his problem with his contracting diaphragm.
Patient symptom list:
- Ringing in the ears and a sensation in his ears of hot wax. He also reported it was as if spiders were crawling in his ears.
- Severe dizziness. The patient describes that he would be in a car and then out of nowhere he would get dizziness and it would feel like the car was flipping end over end.
- Brain fog
- Contracting diaphragm
- Patient’s description at 1:32: “I would just be sitting or standing there, doesn’t matter which, and all of a sudden I couldn’t breathe. Finally, I would take a big gasp of air, and finally, I would be able to breathe.
- Swallowing difficulties: The saliva in his mouth would build up and it was as if he was drowning. This would cause panic attacks.
- The patient also reported when he turned his head to the right, he would lose control of all his muscles and would “drop.”
The patient had these symptoms for 3 – 4 months. It started with a fall of a ladder. Symptoms did not develop for months
- The patient fell off a ladder from a height of 12 feet. He hit a sink and his head snapped backed
- His symptoms started to develop four months after the fall
Because of the nature of his injury and ligament damage in his cervical spine, the patient underwent eight prolotherapy treatment sessions. Here is his description:
- After the eight sessions, the patient reports “almost everything is gone.” A slight ringing in the ears remains but is diminishing.
- The patient did not realize how bad his brain fog was. On his first visit, he had difficulty filling out paperwork. On his last visit he realized filling out the paperwork was “super easy.” It was then he realized the extent of his brain fog.
- The diaphragm problems went away after the 4th or 5th visit along with the swallowing difficulties.
Research on cervical instability and Prolotherapy
Caring Medical has published dozens of papers on Prolotherapy injections as a treatment for difficult-to-treat musculoskeletal disorders. We are going to refer to two of these studies as they relate to cervical instability and a myriad of related symptoms including the problems of swallowing difficulties or cervicogenic dysphagia.
In our own research, our Caring Medical research team published a comprehensive review of the problems related to weakened damaged cervical neck ligaments. (14)
This is what we wrote: “To date, there is no consensus on the diagnosis of cervical spine instability or on traditional treatments that relieve chronic neck instability issues like those mentioned above. In such cases, patients often seek out alternative treatments for pain and symptom relief. Prolotherapy is one such treatment that is intended for acute and chronic musculoskeletal injuries, including those causing chronic neck pain related to underlying joint instability and ligament laxity. While these symptom classifications should be obvious signs of a patient in distress, the cause of the problems is not so obvious. Further and unfortunately, there is often no correlation between the hypermobility or subluxation of the vertebrae, clinical signs or symptoms, or neurological signs (such as swallowing difficulties) or symptoms. Sometimes there are no symptoms at all which further broadens the already very wide spectrum of possible diagnoses for cervical instability.”
What we demonstrated in this study is that the cervical neck ligaments are the main stabilizing structures of the cervical facet joints in the cervical spine and have been implicated as a major source of chronic neck pain and in the case of cervicogenic dysphagia-type symptoms, cervical instability.
Summary and contact us. Can we help you? How do I know if I’m a good candidate?
We hope you found this article informative and that it helped answer many of the questions you may have surrounding Cervical disc disease and difficulty swallowing. Just like you, we want to make sure you are a good fit for our clinic prior to accepting your case. While our mission is to help as many people with chronic pain as we can, sadly, we cannot accept all cases. We have a multi-step process so our team can really get to know you and your case to ensure that it sounds like you are a good fit for the unique testing and treatments that we offer here.
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This article was updated December 7, 2022