Difficulty swallowing with neck up

Introduction The early symptoms of esophageal compression type cervical spondylosis are characterized by difficulty in swallowing when the neck is raised and disappear when the neck is bent. Esophageal compression type cervical spondylosis, also known as dysphagia type cervical spondylosis, is relatively rare in clinical practice. Therefore, it is easy to be misdiagnosed or missed. Mainly due to intervertebral disc degeneration secondary anterior longitudinal ligament and subperiosteal tear, hemorrhage, mechanization, calcification and bone spur formation. The size of the bone spurs varies from medium to small, and the sagittal diameter is less than 5 mm. Since the front of the vertebral body is loose connective tissue and elastic esophagus, the buffer gap is large, so the symptoms are generally not present, but if it occurs, it is easy to cause compression.

Cause

Causes of difficulty swallowing when climbing the neck:

(1) Causes of the disease:

Mainly due to intervertebral disc degeneration secondary anterior longitudinal ligament and subperiosteal tear, hemorrhage, mechanization, calcification and bone spur formation.

(2) Pathogenesis:

Mainly due to intervertebral disc degeneration secondary anterior longitudinal ligament and subperiosteal tear, hemorrhage, mechanization, calcification and bone spur formation. The size of the bone spurs varies from medium to small, and the sagittal diameter is less than 5 mm. Since the front of the vertebral body is loose connective tissue and elastic esophagus, the buffer gap is large, so symptoms are generally not present, but it is easy to cause compression if the following conditions occur.

1. The spur is too large: if the spur is too large (the author encounters more than 1.5cm) and exceeds the anterior vertebral space and the cushioning and compensatory capacity of the esophagus itself, symptoms of esophageal compression may occur.

2. Rapid formation of bone spurs: If the spurs of the vertebral body are rapidly formed due to trauma and other factors, the length is smaller than that of the former. However, due to the inability to adapt and compensate for the soft tissue, the local balance is imbalanced and symptoms are prone to occur.

3. Esophageal abnormalities: clinically, there are cases of spurs that are only 4 to 5 mm long, which are symptoms of dysphagia. This is mainly due to the presence of inflammation (or inflammation around the esophagus) in the esophagus itself, and of course the spirit of the patient. Factors, esophageal activity and local response are directly related.

4. Characteristics of anatomical parts: The presence or absence of symptoms and the appearance of morning and evening, degree, etc. are closely related to the segment of the esophagus. In the cartilage of the ring cartilage (corresponding to the sixth cervical vertebra) and the esophagus of the diaphragm, it is fixed, so that a small bone spur can cause symptoms.

5. Positional influence: When the cervical vertebra is in the upright position, the esophagus is easily tightened due to the tension of the esophagus. When the neck is flexed, the esophagus is in a relaxed state, so it is easy to pass through the food.

an examination

Related inspection

Swallowing test swallowing test

Examination and diagnosis of difficulty in swallowing when neck is raised:

1. Dysphagia: In the early stage, there was a sense of difficulty in swallowing hard foods and an abnormal feeling behind the sternum after eating (burning, tingling, etc.), which gradually affected the swallowing of soft food and liquid diet. The extent of their dysphagia can be divided into:

(1) Mild: It is an early symptom, which is manifested as difficulty in swallowing when the neck is raised, and disappears when the neck is bent.

(2) Moderate: refers to those who can swallow soft food or liquid diet, more common, and more patients come to see.

(3) Heavy: Only water and soup can be eaten, but it is rare.

2. Other cervical spondylosis symptoms: simple esophageal compression type cervical spondylosis patients are rare, about 80% of cases are still accompanied by spinal cord, spinal nerve root or vertebral artery compression symptoms. Therefore, it should be thoroughly examined to find other symptoms.

1. Dysphagia: Early fear of swallowing dry food. The symptoms of the neck flexion are lighter and heavier when stretching.

2. Imaging examination: including X-ray plain film and barium meal examination, etc., can show the formation of callus in front of the vertebral ganglia, and compression of the esophagus caused by stenosis and stenosis, if necessary, MRI and other tests.

3. Other diseases should be excluded: refers to esophageal cancer, sputum sputum, gastroduodenal ulcer, snoring and esophageal diverticulum, etc., if necessary, MRI or fiber esophagoscopy. However, it should be noted that in the case of spurs, fiberoptic esophagoscopy has the risk of esophageal perforation (reported in the literature): the neck should not be overstretched during the insertion of the fiber esophagoscopy to prevent spinal cord hyperextension injury.

Differential diagnosis

Symptoms of dysphagia when swallowing the neck:

Swallowing Disorder: Swallowing is one of the most complex body reflexes and requires good coordination of oral, pharyngeal, larynx and esophageal functions. Dysphagia can lead to dehydration, malnutrition, aspiration pneumonia (recurring), and even suffocation. . From the time of swallowing to the arrival of food at the door, it takes only a few seconds to go through the complex process described above. This indicates that dysphagia occurs when a link in the swallowing reflex arc of normal humans is damaged. Some patients with dysphagia may be killed by so-called aspiration pneumonia, which is caused by a swallowed food that often enters the trachea and causes a lung infection. Therefore, in the early stage of the disease, the swallowing activity is uncoordinated, and the coughing phenomenon often occurs when swallowing, so attention should be paid and the treatment should be checked early.

Dysphagia: When the normal swallowing function is impaired, it is called dysphagia, which is a symptom that is hindered by the food from the mouth to the stomach. It can be caused by functional or organic obstruction of the pharynx, esophagus or spray. The patient adheres, stops, or occludes in the pharynx, behind the sternum, or behind the xiphoid immediately after eating or within 8 to 10 seconds.

There is a blockage or dull pain behind the sternum when swallowing dry food: a blockage or dull pain behind the sternum when swallowing dry food is one of the early and middle stages of esophageal cancer. Mainly for progressive dysphagia, early can only be discomfort or blockage when swallowing, post-sternal pain or post-sternal discomfort when swallowing food.

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