When the Neck Chokes the Throat: Dysphagia from Anterior Cervical Osteophytes Explained

“Dysphagia” simply means difficulty swallowing. People (and even many clinicians) instinctively look to the esophagus—the food pipe—for the cause. But the swallowing system is a coordinated chain that begins in the mouth, funnels through the oropharynx and hypopharynx, and only then enters the esophagus. Bony spurs that grow along the front of the neck vertebrae—called anterior cervical osteophytes—can protrude into this shared corridor and physically indent or irritate the pharynx or upper esophagus. The result can be a mechanical roadblock, altered swallowing mechanics, or inflammatory swelling around a tight space—each of which can produce dysphagia, choking, coughing, or food “sticking” in the throat. ^[1,2,3]

Although osteophytes are common in older adults, only a small fraction become symptomatic. Large reviews estimate that cervical spinal osteophytes are present in roughly one-fifth to one-third of older adults; however, symptomatic dysphagia is uncommon and usually appears when spurs enlarge enough to narrow the pharyngeal passage, inflame nearby tissues, or disturb the motion of the epiglottis. ^[1,4]

Anterior osteophytes are a hallmark of age-related degenerative change, but they are particularly associated with diffuse idiopathic skeletal hyperostosis (also known as Forestier disease), a condition where ligaments and soft tissues ossify along the spine. In the neck, that ossification can form “beak-like” projections that jut forward. Repetitive micro-trauma, chronic inflammation at tendon–bone junctions, and metabolic factors have all been implicated. In many patients, osteophytes are an incidental finding on imaging; in others, they gradually enlarge and begin contacting the swallowing pathway. ^[5–7]

• Adults over 60 years.
• People with diffuse idiopathic skeletal hyperostosis or advanced cervical spondylosis.
• Individuals with longstanding posture strain or previous cervical procedures (less commonly). ^[5–7]

Anterior cervical osteophyte–related dysphagia most often presents with:

• A sensation of food “sticking” high in the throat (more with solids).
• Coughing or choking during meals.
• Throat clearing, gurgly voice, or regurgitation through the nose in advanced cases.
• Weight loss due to avoidance of solid textures.
• Less commonly, hoarseness (if the laryngeal structures are irritated) or noisy breathing and shortness of breath when a very large spur encroaches on the airway. ^[2,3,8–10]

Clues that the problem is not primarily esophageal include difficulty initiating a swallow, coughing or choking immediately as the swallow begins, and symptoms that worsen with head position. By contrast, esophageal rings, strictures, or reflux-related narrowing often cause a later sensation of food getting stuck behind the sternum rather than high in the neck. A careful history helps sort these patterns, but imaging of swallowing physiology is the real differentiator. ^[2,11]

A thoughtful evaluation usually proceeds in steps:

Key point: The combination of motion imaging (videofluoroscopic swallowing study) to identify functional impairment and cross-sectional imaging (computed tomography or magnetic resonance imaging) to delineate anatomy provides the most complete picture. ^[2,11]

Because many patients improve without surgery, clinicians typically begin with non-operative options:

• Dietary modification and swallowing therapy. A speech-language pathologist can tailor textures (moist, softer solids; careful bolus size) and teach postural or compensatory strategies to reduce aspiration risk and improve clearance. ^[2,11]
• Anti-inflammatory medication for symptomatic flares. A short course of non-steroidal anti-inflammatory drugs, with or without other anti-inflammatory measures (for example, reflux control, targeted corticosteroids in select cases), may reduce local swelling around the osteophyte and ease symptoms. ^[12]
• Management of coexisting conditions. Treating laryngopharyngeal reflux, dental issues, and nasal obstruction can help marginally in some individuals.
• Observation with safety netting. Patients are taught red flags: fever, progressive weight loss, repeated pneumonias, or any signs of airway compromise.

In published series, a minority of symptomatic patients maintain long-term control with conservative care alone; persistent disabling dysphagia, aspiration, or airway compromise are the usual triggers to escalate. ^[1,13]

Surgery (anterior osteophytectomy) is considered for patients with significant functional limitation (difficulty maintaining nutrition, repeated aspiration events), failure of comprehensive conservative therapy, or structural encroachment so severe that physiology cannot be improved by therapy alone. ^[14–16]

Through an anterolateral neck approach, the surgeon removes the offending bony projections and relieves the mass effect on the pharynx or esophagus. Some teams also contour adjacent bone to reduce the risk of sharp edges or early regrowth. The procedure is distinct from fusion; in many cases, the focus is purely on spur removal. ^[1,14–16]

Multiple case series report substantial improvements in swallowing scales and patient-reported outcomes within weeks to months after osteophytectomy. Long-term follow-up suggests that most patients sustain benefit, although recurrence of ossification is possible years later, especially in diffuse idiopathic skeletal hyperostosis. This makes ongoing clinical review worthwhile. ^[15,17,18]

As with any neck surgery, there are potential complications: hoarseness from irritation or injury to the recurrent laryngeal nerve, temporary swallowing worsening due to postoperative swelling, infection, hematoma, or, rarely, instability if extensive bone is removed. Reported complication rates are generally low in experienced hands, and careful pre-operative planning mitigates risk. ^[14–16]

Can these spurs really cause aspiration or pneumonia?

Yes. If osteophytes impede epiglottic inversion or create a “shelf” where material pools, thin liquids can penetrate the airway and be aspirated, potentially leading to pneumonias—one reason the videofluoroscopic swallowing study is so informative. ^[2,11]

Why do symptoms vary with head position?

Neck flexion or extension subtly shifts the pharyngeal corridor relative to the spur, changing how much it impinges on the bolus pathway. This can make certain postures feel better or worse and is exactly what therapists leverage during rehabilitation. ^[2]

Will the spurs keep growing?

In diffuse idiopathic skeletal hyperostosis, new ossification can occur over time. After surgery, recurrence has been documented in some patients several years later—often slower and not always symptomatic. Periodic reassessment is reasonable. ^[17,18]

Is this related to the type of dysphagia that follows anterior cervical spine fusion?

No. Post-operative dysphagia after spine surgery has different mechanisms (for example, soft-tissue swelling, retraction injury, plate prominence). However, the evaluation tools overlap, and lessons from post-fusion dysphagia underscore how sensitive the pharynx is to space-occupying change. ^[19]

1. Rule out dangerous mimics quickly. Progressive, painful, or rapidly worsening dysphagia with bleeding, unexplained weight loss, or nighttime breathing symptoms warrants urgent evaluation by an ear, nose and throat specialist and imaging.
2. Obtain motion imaging of swallowing. A videofluoroscopic swallowing study identifies how and where the swallow is failing and whether the osteophyte is the main culprit. ^[2,11]
3. Define anatomy precisely. Computed tomography of the neck with bone windows maps the spur’s level and thickness; magnetic resonance imaging adds soft-tissue detail. ^[1,3]
4. Start conservative therapy. Diet adjustment, posture techniques, and targeted medical therapy are first-line and often sufficient for milder cases. ^[12]
5. Escalate when function or safety is compromised. Persistent aspiration, malnutrition, or airway threat justifies surgical removal, which yields high rates of symptomatic relief in reported cohorts. ^[14–16]

Not every swallowing problem begins in the esophagus. In select patients—especially older adults and those with diffuse idiopathic skeletal hyperostosis—anterior cervical osteophytes physically crowd the throat and disrupt the choreography of a safe swallow. The right tests visualize both function (videofluoroscopic swallowing study) and form (computed tomography or magnetic resonance imaging). Many people improve with therapy and medical measures, but when symptoms are severe, surgical osteophytectomy is a proven option with generally favorable outcomes and a watchful eye on long-term recurrence. ^{[1, 2,3]}