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Diagnosis and Management of Cervical Spondylosis Medication

  • Author: Sandeep S Rana, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
Updated: Aug 06, 2015

Medication Summary

The goal of pharmacotherapy is to reduce pain and inflammation.


Nonsteroidal anti-inflammatory drugs

Class Summary

Used most commonly for the relief of mild to moderate pain. Although the effects of NSAIDs in the treatment of pain tend to be patient specific, ibuprofen is usually the DOC for initial therapy. Other options include naproxen and diclofenac.

Ibuprofen (Motrin, Advil, Haltran, Nuprin)


Inhibits inflammatory reactions and pain by decreasing activity of COX, which results in prostaglandin synthesis.

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)


Relieves mild to moderate pain; inhibits inflammatory reactions and pain, probably by decreasing activity of COX, which results in decreased prostaglandin synthesis.

Diclofenac (Voltaren)


Has analgesic, antipyretic, and anti-inflammatory activity; inhibits inflammatory reactions and pain, probably by decreasing activity of COX, which results in prostaglandin synthesis.



Class Summary

Used for potent anti-inflammatory activity and relieve inflammation associated with cervical radiculopathy.

Prednisone (Sterapred)


Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability.

Methylprednisolone (Adlone, Medrol, Solu-Medrol, Depo-Medrol, Depopred)


Decreases inflammation by suppressing migration of PMN leukocytes and reversing increased capillary permeability.


Tricyclic antidepressants

Class Summary

A complex group of drugs that has central and peripheral anticholinergic effects and sedative effects. They block the active reuptake of norepinephrine and serotonin.

Amitriptyline (Elavil)


Increases synaptic concentration of serotonin and/or norepinephrine in CNS by inhibiting their reuptake at presynaptic neuronal membrane; useful as an analgesic for certain chronic and neuropathic pain.

Nortriptyline (Aventyl hydrochloride, Pamelor)


Effective in treatment of chronic pain; by inhibiting reuptake of serotonin and/or norepinephrine at the presynaptic neuronal membrane, it increases their synaptic concentration; additional pharmacodynamic effects (eg, desensitization of adenyl cyclase, down-regulation of beta-adrenergic receptors and serotonin receptors) appear to be involved.


Cyclooxygenase 2 inhibitors

Class Summary

Although increased cost can be a negative factor, incidence of costly and potentially fatal GI bleeding is clearly less with COX-2 inhibitors than with traditional NSAIDs. Ongoing analysis of cost avoidance of GI bleeding will further define populations that most benefit from COX-2 inhibitors.

Celecoxib (Celebrex)


Inhibits primarily COX-2, which is considered an inducible isoenzyme induced during pain and inflammatory stimuli; inhibition of COX-1 may contribute to NSAID GI toxicity; at therapeutic concentrations, COX-1 isoenzyme is not inhibited, thus GI toxicity may be decreased; seek lowest dose for each patient.


Muscle relaxants

Class Summary

Reduce associated cervical muscle spasm.

Carisoprodol (Soma)


Short-acting medication that may have depressant effects at spinal cord level.

Cyclobenzaprine (Flexeril)


Skeletal muscle relaxant that acts centrally and reduces motor activity of tonic somatic origins, influencing both alpha and gamma motor neurons; structurally related to TCAs and thus carries some of same liabilities.



Class Summary

For use in short-term management of acute pain.

Hydrocodone and acetaminophen (Vicodin, Lortab, Norcet, Margesic, Lorcet-HD)


Drug combination indicated for moderately severe to severe pain.

Oxycodone and acetaminophen (Percocet, Roxicet, Roxilox, Tylox)


Drug combination indicated for relief of moderately severe to severe pain.

Contributor Information and Disclosures

Sandeep S Rana, MD Clinical Associate Professor of Neurology, Drexel University College of Medicine

Sandeep S Rana, MD is a member of the following medical societies: American Academy of Neurology, American Society of Neuroimaging, Pennsylvania Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American College of International Physicians, American Heart Association, American Stroke Association, American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, National Association of Managed Care Physicians, American College of Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

William J Nowack, MD Associate Professor, Epilepsy Center, Department of Neurology, University of Kansas Medical Center

William J Nowack, MD is a member of the following medical societies: American Academy of Neurology, Biomedical Engineering Society, American Clinical Neurophysiology Society, American Epilepsy Society, EEG and Clinical Neuroscience Society, American Medical Informatics Association

Disclosure: Nothing to disclose.


The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Eli M Baron, MD and William F Young, MD to the development and writing of this article.

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A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. T2-weighted sagittal MRI shows ventral osteophytosis, most prominent between C4 and C7, with reduction of the ventral cerebrospinal fluid sleeve.
A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. Axial gradient echo MRI shows moderate anteroposterior narrowing of the cord space due to a ventral osteophyte at the C4 level, with bilateral narrowing of the neural foramina (more prominently on the left side).
A 48-year-old man presented with neck pain and predominantly left-sided radicular symptoms in the arm. The patient's symptoms resolved with conservative therapy. Axial CT scan at C5-6 demonstrates a large ventral osteophyte (see arrow). In addition, uncinate process hypertrophy is present bilaterally and the right neural foramen is narrowed.
T2-weighted sagittal MRI of a 59-year-old woman who presented with a spastic gait and weakness in her upper extremities showing cord compression from cervical spondylosis, which caused central spondylotic myelopathy. Note the signal changes in the cord at C4-C5, the ventral osteophytosis, buckling of the ligamentum flavum at C3-C4, and the prominent loss of disk height between C2 and C5.
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