Cervical Spondylosis Medication
- Author: Hassan Ahmad Hassan Al-Shatoury, MD, PhD, MHPE; Chief Editor: Dean H Hommer, MD more...
The goal of pharmacotherapy is to reduce morbidity and prevent complications.
Nonsteroidal anti-inflammatory drugs
Nonsteroidal anti-inflammatory drugs (NSAIDs) are used in the treatment of cervical spondylosis. If one class seems to be ineffective after a 2-week trial, a formulation from another class may be tried. The most commonly used NSAIDs are ibuprofen, acetylsalicylic acid, naproxen, indomethacin, meloxicam, and piroxicam.
Relieves mild to moderately severe pain and inhibits inflammatory reactions, probably by decreasing the activity of the enzyme cyclooxygenase, thus inhibiting prostaglandin synthesis.
NSAID from propionic acid derivatives group. Effective inhibitor of cyclo-oxygenase, which is responsible for biosynthesis of prostaglandins. Rapidly absorbed after oral administration. Half-life in plasma is about 2 h. Ibuprofen passes slowly into the synovial spaces and may remain there in higher concentration as the concentration in plasma declines. Excretion is rapid and complete (mainly excreted in urine as metabolites or conjugates).
Rapidly absorbed; metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation. Indomethacin inhibits prostaglandin synthesis.
Decreases the activity of cyclooxygenase, which in turn inhibits prostaglandin synthesis; piroxicam's effects decrease the formation of inflammatory mediators.
Treats mild to moderately severe pain and headache. The drug inhibits prostaglandin synthesis, which prevents the formation of platelet-aggregating thromboxane A2; aspirin acts on the heat-regulating center of the hypothalamus and vasodilates peripheral vessels to reduce fever. By inhibiting prostaglandin synthesis, aspirin may also inhibit key steps in the inflammation process.
Meloxicam has anti-inflammatory effects systemically and can reduce the effect of local inflammatory mediators.
Corticosteroids have potent anti-inflammatory properties. These medications can be given as a brief tapered course of oral treatment.
Glucocorticoid steroid used to treat a variety of inflammatory conditions. Prednisone may decrease inflammation by reversing increased capillary permeability and suppressing PMN activity. Dosages may be adjusted for individual sensitivities and associated medical conditions.
Muscle relaxants are used to treat muscle spasm, which may play a role in patient discomfort.
Skeletal muscle relaxant used in conjunction with other therapies to treat pain and discomfort associated with musculoskeletal conditions. Reduces nerve impulse transmission from spinal cord to skeletal muscle.
These agents are useful in select cases of chronic pain.
Antidepressant with sedative effects. The mechanism of action is unknown. Amitriptyline is not an MAOI and does not act primarily by stimulating CNS.
Epstein N. Posterior approaches in the management of cervical spondylosis and ossification of the posterior longitudinal ligament. Surg Neurol. 2002 Sep-Oct. 58(3-4):194-207; discussion 207-8. [Medline].
Epstein N. Ossification of the cervical posterior longitudinal ligament: a review. Neurosurg Focus. 2002 Aug 15. 13(2):ECP1. [Medline].
Ozer AF, Oktenoglu T, Cosar M, et al. Long-term follow-up after open-window corpectomy in patients with advanced cervical spondylosis and/or ossification of the posterior longitudinal ligament. J Spinal Disord Tech. 2009 Feb. 22(1):14-20. [Medline].
Wang MC, Kreuter W, Wolfla CE, et al. Trends and variations in cervical spine surgery in the United States: Medicare beneficiaries, 1992 to 2005. Spine. 2009 Apr 2. [Medline].
Wang C, Tian F, Zhou Y, He W, Cai Z. The incidence of cervical spondylosis decreases with aging in the elderly, and increases with aging in the young and adult population: a hospital-based clinical analysis. Clin Interv Aging. 2016. 11:47-53. [Medline]. [Full Text].
Miranda P, Gomez P, Alday R. Acute traumatic central cord syndrome: analysis of clinical and radiological correlations. J Neurosurg Sci. 2008 Dec. 52(4):107-12; discussion 112. [Medline].
Patel AA, Spiker WR, Daubs M, Brodke DS, Cannon-Albright LA. Evidence of an inherited predisposition for cervical spondylotic myelopathy. Spine (Phila Pa 1976). 2012 Jan 1. 37(1):26-9. [Medline]. [Full Text].
Kuijper B, Tans JT, van der Kallen BF, Nollet F, Lycklama A Nijeholt GJ, de Visser M. Root compression on MRI compared with clinical findings in patients with recent onset cervical radiculopathy. J Neurol Neurosurg Psychiatry. 2011 May. 82(5):561-3. [Medline].
Banaszek A, Bladowska J, Szewczyk P, et al. Usefulness of diffusion tensor MR imaging in the assessment of intramedullary changes of the cervical spinal cord in different stages of degenerative spine disease. Eur Spine J. 2014 Jul. 23(7):1523-30. [Medline].
Tsiptsios I, Fotiou F, Sitzoglou K, et al. Neurophysiological investigation of cervical spondylosis. Electromyogr Clin Neurophysiol. 2001 Jul-Aug. 41(5):305-13. [Medline].
Weber M, Eisen A. Are motor evoked potentials (MEPs) helpful in the differential diagnosis of spondylotic cervical myelopathy (SCM)?. Suppl Clin Neurophysiol. 2000. 53:419-23. [Medline].
Stetkarova I, Kofler M. Cutaneous silent periods in the assessment of mild cervical spondylotic myelopathy. Spine. 2009 Jan 1. 34(1):34-42. [Medline].
Uribe JS, Sangala JR, Duckworth EA, et al. Comparison between anterior cervical discectomy fusion and cervical corpectomy fusion using titanium cages for reconstruction: analysis of outcome and long-term follow-up. Eur Spine J. 2009 Feb 12. [Medline].
Ramzi N, Ribeiro-Vaz G, Fomekong E, et al. Long term outcome of anterior cervical discectomy and fusion using coral grafts. Acta Neurochir (Wien). 2008 Dec. 150(12):1249-56; discussion 1256. [Medline].
Epstein NE. Laminectomy for cervical myelopathy. Spinal Cord. 2003 Jun. 41(6):317-27. [Medline].
Wang MY, Shah S, Green BA. Clinical outcomes following cervical laminoplasty for 204 patients with cervical spondylotic myelopathy. Surg Neurol. 2004 Dec. 62(6):487-92; discussion 492-3. [Medline].
Fehlings MG, Smith JS, Kopjar B, Arnold PM, Yoon ST, Vaccaro AR, et al. Perioperative and delayed complications associated with the surgical treatment of cervical spondylotic myelopathy based on 302 patients from the AOSpine North America Cervical Spondylotic Myelopathy Study. J Neurosurg Spine. 2012 Feb 10. [Medline].
Seebach CL, Kirkhart M, Lating JM, Wegener ST, Song Y, Riley LH 3rd, et al. Examining the role of positive and negative affect in recovery from spine surgery. Pain. 2012 Mar. 153(3):518-25. [Medline].
Wang MC, Chan L, Maiman DJ, et al. Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine. 2007 Feb 1. 32(3):342-7. [Medline].
Alexander JT. Natural history and nonoperative management of cervical spondylosis. Menezes AH, Sonnatage VH, eds. Principles of Spinal Surgery. New York, NY: McGraw-Hill; 1996. 547-57.
Binder AI. Cervical spondylosis and neck pain. BMJ. 2007 Mar 10. 334(7592):527-31. [Medline].
Braddom RL. Management of common cervical pain syndromes. DeLisa JA, ed. Rehabilitation Medicine: Principles and Practice. Philadelphia, Pa: Lippincott Williams & Wilkins; 1993. 1036-46.
Carr RG. The physiatrist and cervical spondylosis. Saunders RL, Bernini PM, eds. Cervical Spondylotic Myelopathy. Boston, Mass: Blackwell Scientific; 1992. 96-109.
Chan CW. Spinal cord injury. Sinaki M, ed. Basic Clinical Rehabilitation Medicine. Minneapolis, Minn: Mosby-Year Book; 1993. 183-94.
Clark CR. Degenerative conditions of the spine: differential diagnosis and non-surgical treatment. Frymoyer JW, ed. The Adult Spine: Principles and Practice. New York, NY: Raven Press; 1991. 1154-64.
Fiscgrund JS, Herkowitz HN. Cervical spondylotic radiculopathy, natural history and pathophysiology. Herkowitz HN, Rothman RH, Simeone FA, eds. Rothman-Simeone, the Spine. 4th ed. Philadelphia, Pa: WB Saunders; 1999. 461-5.
Fouyas IP, Statham PF. Operative treatment of cervical spondylosis. Br J Neurosurg. 1998 Dec. 12(6):594-5. [Medline].
Hoff JT, Panadopoulos SM. Cervical disc disease and cervical spondylosis. Wilkins RH, Rengachary SS, eds. Neurosurgery. New York, NY: McGraw-Hill; 1996. 3756-74.
Iwabuchi M, Kikuchi S, Sato K. Pathoanatomic investigation of cervical spondylotic myelopathy. Fukushima J Med Sci. 2004 Dec. 50(2):47-54. [Medline].
Jumah KB, Nyame PK. Relationship between load carrying on the head and cervical spondylosis in Ghanaians. West Afr J Med. 1994 Jul-Sep. 13(3):181-2. [Medline].
Kadanka Z, Mares M, Bednarík J, et al. Predictive factors for mild forms of spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol. 2005 Jan. 12(1):16-24.
Kadanka Z, Mares M, Bednarík J, et al. Predictive factors for spondylotic cervical myelopathy treated conservatively or surgically. Eur J Neurol. 2005 Jan. 12(1):55-63.
Kawaguchi Y, Kanamori M, Ishihara H, et al. Pathomechanism of myelopathy and surgical results of laminoplasty in elderly patients with cervical spondylosis. Spine. 2003 Oct 1. 28(19):2209-14. [Medline].
Kimura R, Park YS, Nakase H, et al. Syringomyelia caused by cervical spondylosis. Acta Neurochir (Wien). 2004 Feb. 146(2):175-8. [Medline].
Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain. 1972. 95(1):87-100. [Medline].
Papadopoulos CA, Katonis P, Papagelopoulos PJ, et al. Surgical decompression for cervical spondylotic myelopathy: correlation between operative outcomes and MRI of the spinal cord. Orthopedics. 2004 Oct. 27(10):1087-91. [Medline].
Rao RD, Currier BL, Albert TJ, et al. Degenerative cervical spondylosis: clinical syndromes, pathogenesis, and management. J Bone Joint Surg Am. 2007 Jun. 89(6):1360-78. [Medline].
Sakaura H, Hosono N, Mukai Y, et al. Long-term outcome of laminoplasty for cervical myelopathy due to disc herniation: a comparative study of laminoplasty and anterior spinal fusion. Spine. 2005 Apr 1. 30(7):756-9. [Medline].
Sari-Kouzel H, Cooper R. Managing pain from cervical spondylosis. Practitioner. 1999 Apr. 243(1597):334-8. [Medline].
Singh A, Crockard HA, Platts A, et al. Clinical and radiological correlates of severity and surgery-related outcome in cervical spondylosis. J Neurosurg. 2001 Apr. 94(2 Suppl):189-98. [Medline].