Dysphagia Due to Cervical Spondylosis

CERVICAL spondylosis, formerly called osteoarthritis of spine, has recently been found to be the cause of serious neurological disorders: compression of the spinal cord, causing spastic paraplegia and weakness of arms (Bedford et al., 1952; K. L. Allen, 1952), and compression of cervical nerve roots, producing weakness and atrophy in the upper extremities with sensory and reflex disturbances (Epstein and Davidoff, 1951; W. Russell Brain et al., 1952); pain, radiating into the extremities and between the shoulderblades, may be mistaken for angina pectoris (Falk, 1941). Yet cervical spondylosis is hardly ever mentioned as a cause of dysphagia. No specimens in pathological museums are available to demonstrate the relationship between the two conditions and only a few and scattered papers referring to the problem can be found in the literature. Falk, in 1940, found only eight cases, Kertzner and Madden, in 1950, were able to collect 14 cases, including one of their own and Piquet, in 1951, only 20. The occurrence of even one single case is still considered worthwhile reporting (Henschel, 1952) and so the impression is created that dysphagia due to cervical spondylosis is a rarity. But the condition is far .from rare and the author has seen six instances of it in one year alone. It is likely that many cases pass unrecognized because the relationship of the spondylosis to dysphagia is not appreciated. The reason for this is twofold: (1) patients do not die of the condition, so that there is no opportunity for a post-mortem examination, and (2) even if an autopsy is performed in the routine manner and cervical spondylosis found, the connection between the spondylosis and dysphagia—if it did exist during life —is missed because of the customary way of removing the pharynx and oesophagus. As a rule these organs are taken out en bloc, together with the larynx, trachea, lungs and pericardium by traction on the tongue, the retropharyngeal tissues in front of the vertebral column remaining in situ. This method of removal disturbs the topographical relationship of the retropharyngeal tissues to the pharynx and oesophagus on the one hand and to the vertebral column on the other.