Retrospective chart review of cervical spinal cord injury patients, who underwent videofluoroscopic swallowing study (VFSS).To evaluate the swallowing function of cervical spinal cord injury patients, analyze the features of dysphagia and investigate their association with the clinical symptoms and signs.Spinal Cord Injury Unit, Yonsei Rehabilitation Hospital, Seoul, Korea.Retrospective study (1 May 2001-31 May 2008) on inpatients with tetraplegia. All enrolled patients underwent VFSS, and their results were correlated with clinical data including symptoms and signs indicative of dysphagia.A total of 121 cervical spinal cord injury patients (106 male and 16 female patients) were included in this study. Ten patients showed evidence of aspiration on VFSS. Statistical correlation to aspiration was found with age, presence of tracheostomy, and symptoms and signs indicating dysphagia. However, out of the 10 patients with evident aspiration, 2 patients did not show any symptoms or signs indicating aspiration.Because of the possibility of silent aspiration, we recommend that physicians treating patients with cervical spinal cord injury should always take the possibility of dysphagia and silent aspiration into consideration, especially in case of previous manifestation of pneumonia, presence of tracheostomy, or presence of signs and symptoms indicating dysphagia.