Cervical Disc Injuries Medication
- Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Sherwin SW Ho, MD more...
Oral nonsteroidal anti-inflammatory drugs (NSAIDs) can help decrease pain and inflammation. Various oral NSAIDs can be used, and none of these holds a clear distinction as the drug of choice. The choice of NSAIDs is largely a matter of convenience (how frequently doses must be taken to achieve adequate analgesic and anti-inflammatory effects) and cost.
Nonsteroidal anti-inflammatory drugs
Have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclo-oxygenase activity and prostaglandin synthesis. Other mechanisms may exist as well, such as inhibition of leukotriene synthesis, lysosomal enzyme release, lipoxygenase activity, neutrophil aggregation, and various cell membrane functions.
For arthritis. Inhibits primarily COX-2. COX-2 is considered an inducible isoenzyme, induced by 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 of celecoxib for each patient.
DOC for patients with mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.
For relief of mild to moderate pain and inflammation. Small dosages initially are indicated in small and elderly patients and in those with renal or liver disease. Doses over 75 mg do not increase therapeutic effects. Administer high doses with caution, and closely observe patient for response.
For relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of cyclo-oxygenase, which results in a decrease of prostaglandin synthesis.
Boden SD, McCowin PR, Davis DO, Dina TS, Mark AS, Wiesel S. Abnormal magnetic-resonance scans of the cervical spine in asymptomatic subjects. A prospective investigation. J Bone Joint Surg Am. 1990 Sep. 72(8):1178-84. [Medline].
Ernst CW, Stadnik TW, Peeters E, Breucq C, Osteaux MJ. Prevalence of annular tears and disc herniations on MR images of the cervicalspine in symptom free volunteers. Eur J Radiol. 2005 Sep. 55(3):409-14. [Medline].
Bogduk N, Tynan W, Wilson AS. The nerve supply to the human lumbar intervertebral discs. J Anat. 1981 Jan. 132(Pt 1):39-56. [Medline].
Mercer S, Bogduk N. The ligaments and annulus fibrosus of human adult cervical intervertebral discs. Spine. 1999 Apr 1. 24(7):619-26; discussion 627-8. [Medline].
Torg J. Epidemiology, pathomechanics, and prevention of athletic injuries to the cervical spine. The Cervical Spine. 1989. 442-463.
Torg JS, Corcoran TA, Thibault LE, Pavlov H, Sennett BJ, Naranja RJ Jr, et al. Cervical cord neurapraxia: classification, pathomechanics, morbidity, and management guidelines. J Neurosurg. 1997 Dec. 87(6):843-50. [Medline].
Mall NA, Buchowski J, Zebala L, Wright RW, Matava MJ. Spine and axial skeleton injuries in the national football league. Am J Sports Med. 2012 Aug. 40(8):1755-61. [Medline].
National Collegiate Athletic Association. Article 2-1,2-N 1976; Rule 2, Section 24; Rule 9, Section 1. Football rule changes and modifications. 1976.
American Academy of Pediatrics. Trampoline. Pediatrics. 1981. 67:438.
Tator CH, Edmonds VE. National survey of spinal injuries in hockey players. Can Med Assoc J. 1984 Apr 1. 130(7):875-80. [Medline].
Mochida K, Komori H, Okawa A, Muneta T, Haro H, Shinomiya K. Regression of cervical disc herniation observed on magnetic resonance images. Spine. 1998 May 1. 23(9):990-5; discussion 996-7. [Medline].
Nachemson, Alf L. The lumbar spine: An orthopedic challenge. Spine. 1976. 1(1):
Coventry MB, Ghormley RK, Kernahan JW. The intervertebral disc: Its microscopic anatomy and pathology. Part III: Pathologic changes in the intervertebral disc. J Bone and Joint Surg. 1945. 27:460-474.
Gower WE, Pedrini V. Age-related variations in proteinpolysaccharides from human nucleus pulposus, annulus fibrosus, and costal cartilage. J Bone Joint Surg Am. 1969 Sep. 51(6):1154-62. [Medline].
Lipson SJ, Muir H. Experimental intervertebral disc degeneration: morphologic and proteoglycan changes over time. Arthritis Rheum. 1981 Jan. 24(1):12-21. [Medline].
Pearce RH, Grimmer BJ, Adams ME. Degeneration and the chemical composition of the human lumbar intervertebral disc. J Orthop Res. 1987. 5(2):198-205. [Medline].
Torg JS, Sennett B, Pavlov H, Leventhal MR, Glasgow SG. Spear tackler's spine. An entity precluding participation in tackle football and collision activities that expose the cervical spine to axial energy inputs. Am J Sports Med. 1993 Sep-Oct. 21(5):640-9. [Medline].
Nakashima H, Yukawa Y, Suda K, Yamagata M, Ueta T, Kato F. Abnormal Findings on Magnetic Resonance Images of the Cervical Spines in 1,211 Asymptomatic Subjects. Spine (Phila Pa 1976). 2015 Jan 12. [Medline].
Tomasino A, Gebhard H, Parikh K, Wess C, Härtl R. Bioabsorbable instrumentation for single-level cervical degenerative disc disease: a radiological and clinical outcome study. J Neurosurg Spine. 2009 Nov. 11(5):529-37. [Medline].
Phillips FM, Tzermiadianos MN, Voronov LI, Havey RM, Carandang G, Dooris A, et al. Effect of two-level total disc replacement on cervical spine kinematics. Spine (Phila Pa 1976). 2009 Oct 15. 34(22):E794-9. [Medline].
Peng CW, Quirnoa M, Bendo JA, Spivak JM, Goldstein JA. Effect of intervertebral disc height on postoperative motion and clinical outcomes after Prodisc-C cervical disc replacement. Spine J. 2009 Jul. 9(7):551-5. [Medline].
Gore DR, Sepic SB. Anterior cervical fusion for degenerated or protruded discs. A review of one hundred forty-six patients. Spine. 1984 Oct. 9(7):667-71. [Medline].
Flynn TB. Neurologic complications of anterior cervical interbody fusion. Spine. 1982 Nov-Dec. 7(6):536-9. [Medline].
Johnson JP, Filler AG, McBride DQ, Batzdorf U. Anterior cervical foraminotomy for unilateral radicular disease. Spine. 2000 Apr 15. 25(8):905-9. [Medline].
Tu TH, Wu JC, Fay LY, Ko CC, Huang WC, Cheng H. Vertebral body split fracture after a single-level cervical total disc replacement. J Neurosurg Spine. 2012 Mar. 16(3):231-5. [Medline].
Miyazaski K, Hirohuji E, Ono S, et al. Extensive simultaneous multisegment laminectomy and posterior decompression with posterolateral fusion. Jpn Spine Res Soc. 5:167.
Pointillart V. Cervical disc prosthesis in humans: first failure. Spine. 2001 Mar 1. 26(5):E90-2. [Medline].
Goffin J, Casey A, Kehr P, Liebig K, Lind B, Logroscino C. Preliminary clinical experience with the Bryan Cervical Disc Prosthesis. Neurosurgery. 2002 Sep. 51(3):840-5; discussion 845-7. [Medline].
Aydin Y, Kaya RA, Can SM, Türkmenoglu O, Cavusoglu H, Ziyal IM. Minimally invasive anterior contralateral approach for the treatment of cervicaldisc herniation. Surg Neurol. 2005 Mar. 63(3):210-8; discussion 218-9. [Medline].
Whang PG, Simpson AK, Rechtine G, Grauer JN. Current trends in spinal arthroplasty: an assessment of surgeon practices and attitudes regarding cervical and lumbar disk replacement. J Spinal Disord Tech. 2009 Feb. 22(1):26-33. [Medline].
Buchowski JM, Anderson PA, Sekhon L, Riew KD. Cervical disc arthroplasty compared with arthrodesis for the treatment of myelopathy. Surgical technique. J Bone Joint Surg Am. 2009 Oct 1. 91 Suppl 2:223-32. [Medline].
Lin CY, Kang H, Rouleau JP, Hollister SJ, Marca FL. Stress analysis of the interface between cervical vertebrae end plates and the Bryan, Prestige LP, and ProDisc-C cervical disc prostheses: an in vivo image-based finite element study. Spine (Phila Pa 1976). 2009 Jul 1. 34(15):1554-60. [Medline].
Torg JS, Ramsey-Emrhein JA. Suggested management guidelines for participation in collision activities with congenital, developmental, or post-injury lesions involving the cervical spine. Med Sci Sports Exerc. 1997. 29:256-272.
Cantu RC. Functional cervical spinal stenosis: a contraindication to participation in contact sports. Med Sci Sports Exerc. 1993 Mar. 25(3):316-7. [Medline].
Morganti C. Recommendations for return to sports following cervical spine injuries. Sports Med. 2003. 33(8):563-73. [Medline].
Cantu RC, Bailes JE, Wilberger JE Jr. Guidelines for return to contact or collision sport after a cervical spine injury. Clin Sports Med. 1998 Jan. 17(1):137-46. [Medline].
Duggal N, Pickett GE, Mitsis DK, Keller JL. Early clinical and biomechanical results following cervical arthroplasty. Neurosurg Focus. 2004 Sep 15. 17(3):E9. [Medline].
North American Spine Society. Orthopaedic Knowledge Update: Spine. American Academy of Orthopaedic Surgeons; 1997. 75, 97-101.
Sasai K, Saito T, Ohnari H, Yamamoto T, Kasuya T, Wakabayashi E, et al. Microsurgical posterior herniotomy with en bloc laminoplasty: alternative methodfor treating cervical disc herniation. J Spinal Disord Tech. 2005 Apr. 18(2):171-7. [Medline].