The Study:  Cause of Dysphagia in a Patient With Cervical Spondylosis         

The Facts:

a. There are many conditions that can cause dysphagia in a 70 year old patient.

b. This is a case history that describes a 70 year old patient suffering from dysphagia who received chiropractic treatment.

c. The patient suffered with upper neck stiffness and dysphagia.

d. She had difficulty swallowing for approximately 3 years.

e. She reported that in the last year she “had often chocked even on liquids.”

f. The patient had sought help from both a speech therapist and an acupuncturist without result.  

g. She was found to have restricted neck motion and moderate thoracic kyphosis.

h. Radiographs were obtained of both the cervical and thoracic areas.

i. Diagnosis was cervical spondylosis and a vertical atlantoaxial subluxation.”

j. “Initial chiropractic intervention had consisted of stabilizing cervical subluxation and restoring joint mobility, with emphasis on cervical mobilization and strengthening exercises.”

k. “After 3 treatment sessions in the first week, her neck stiffness and swallowing problems were mostly resolved. Cervical spine manipulation in prone position was additionally applied for the correction of forward shifting of the vertical alignment.” 

l. She was seen two times per week over an eight week period.

m. At the end of treatment radiographs were once again obtained and “cervical curvature, Cobb angle, Ranawat index, and C2 to C7 vertical alignment were all improved.”

n. The authors state that: “The aim of chiropractic treatment tailored for this patient was to relieve the brainstem compression, stabilize the joint subluxation, stretch the shortened muscles, and mobilize the joint stiffness.”

o. Upon follow up at 6 months, the patient reported that she could eat a normal diet without choking. 

p. The authors indicated that further research in this area was warranted.

Take Home:

After suffering for three years, the patient’s dysphagia appeared to resolve following a brief period of chiropractic care.

Reviewer's Comments: As always, this is just one case and you don’t wants to read too much into a single case. But I found it very interesting and I would like to see researchers look into this area of interest.

Reviewer:  Roger Coleman DC 

Editor’s Comments: The Ranawat index cited above is used to assess vertical subluxation of C1 on C2 defined as a “settling” of C1 downward on the C2 segment. In case you aren’t familiar with the method (I wasn’t!) here’s a URL, complete with pictures, which describes the Ranawat Index along with the McGregor method, an alternate way of detecting vertical C1 subluxation. As we always caution, case studies have essentially no statistical value but this one was informative and depicted an interesting and unique approach. Congratulations to the authors.

https://www.medscape.com/answers/398955-166651

Editor: Mark R. Payne DC

Reference: Eric Chun Pu Chu, Hong Sing Fai Shum, Andy Fu Chieh Lin. Unusual Cause of Dysphagia in a Patient With Cervical Spondylosis. Clin Med Insights Case Rep. 2019; 12: 1179547619882707. Published online 2019 Dec 29

Link to Abstract: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937524/

Link to Full Text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937524/pdf/10.1177_1179547619882707.pdf