Lumbosacral Spondylolysis Medication

  • Author: Achilles Litao, MD; Chief Editor: Craig C Young, MD   more...
 
Updated: Dec 14, 2011
 

Medication Summary

Tylenol (acetaminophen) and NSAIDs are the mainstays of pain control in those with lumbosacral spondylolysis (lumbar spondylolysis). Moreover, a short course of narcotic analgesics can help those who are in significant acute pain initially.

Muscle relaxants are overprescribed and have not been demonstrated to be of significant help in this condition.

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Analgesics

Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who experience pain.

For the relief of moderate to severe pain, a short course of a narcotic analgesic may be warranted. Opiates exert their effects by binding to different opioid receptors throughout the body, which produces a wide range of effects such as analgesia, euphoria, constipation, and respiratory depression.

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Acetaminophen (Tylenol, Feverall, Aspirin-Free Anacin)

 

Effective analgesic-antipyretic but only has weak anti-inflammatory effects. Inhibits prostaglandin synthetase. Well absorbed from gastrointestinal tract. Peak concentrations in serum are reached within 2 h.

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Acetaminophen and codeine (Tylenol #3)

 

Indicated for the treatment of mild to moderate pain.

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

 

Drug combination indicated for moderate to severe pain. Available in different strengths.

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Hydrocodone and ibuprofen (Vicoprofen)

 

Drug combination indicated for short-term (< 10 d) relief of moderate to severe acute pain.

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Propoxyphene/acetaminophen (Darvocet-N100, Wygesic)

 

Drug combination indicated for mild to moderate pain.

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Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Class Summary

NSAIDs have analgesic, anti-inflammatory, and antipyretic activities. Their mechanism of action is not known, but they may inhibit cyclooxygenase (COX) 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.

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Naproxen (Anaprox, Naprelan, Naprosyn, Aleve)

 

For the relief of mild to moderate pain. Inhibits inflammatory reactions and pain by decreasing activity of COX, which results in a decrease of prostaglandin synthesis.

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Ibuprofen (Motrin, Ibuprin, Advil)

 

NSAIDS exert their main therapeutic effect on pain and inflammation principally by inhibition of prostaglandin synthesis.

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Mefenamic acid (Ponstel)

 

Inhibits inflammatory reactions and pain by decreasing prostaglandin synthesis.

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Ketoprofen (Orudis, Oruvail, Actron)

 

For the relief of mild to moderate pain and inflammation.

Small dosages are initially indicated in small and elderly patients and in those with renal or liver disease.

Doses >75 mg do not increase the therapeutic effects. Administer high doses with caution and closely observe the patient for response.

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Celecoxib (Celebrex)

 

Inhibits primarily COX-2. COX-2 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 the lowest dose of celecoxib for each patient.

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Muscle Relaxants

Class Summary

Muscle relaxants are overprescribed and have not been demonstrated to be of significant help in cases of lumbosacral spondylolysis (lumbar spondylolysis).

Methocarbamol/aspirin (Robaxisal)

 

Used mainly as adjunctive treatment of muscle spasm associated with acute painful musculoskeletal conditions. Causes musculoskeletal relaxation by decreasing impulse transmission from the spinal cord to the muscle.

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Contributor Information and Disclosures
Author

Achilles Litao, MD  Consulting Staff, Department of Pediatrics, MedCentral, Mansfield, Ohio

Achilles Litao, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Achilles Litao, MD  Consulting Staff, Department of Pediatrics, MedCentral, Mansfield, Ohio

Achilles Litao, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Sports Medicine, and American Medical Association

Disclosure: Nothing to disclose.

John Munyak, MD  Associate Program Director, Director of Sports Medicine Education, Department of Emergency Medicine, Lincoln Medical and Mental Health Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Andrew D Perron, MD  Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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

Disclosure: Medscape Salary Employment

Henry T Goitz, MD  Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Jon B Whitehurst, MD  Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital

Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America

Disclosure: Nothing to disclose.

Chief Editor

Craig C Young, MD  Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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Radiograph of L4 defect in the pars interarticularis.
Computed tomography scan demonstrating defects in the left and right pars interarticularis.
Long TR (T2-weighted) fat suppressed sagittal magnetic resonance image shows increased signal in the pars interarticularis on the left at L5 (same patient in Images 3-4). This is an acute stress reaction.
Sagittal short TR (T1-weighted) magnetic resonance image shows decreased signal in the pars interarticularis on the left at L5 (same patient in Images 3-4).
Lateral radiograph of the lumbar spine shows spondylolysis at L5 with spondylolisthesis at L5 through S1. On this single view, it is not possible to determine if these pars defects are unilateral or bilateral. Oblique views may help resolve this issue.
Sagittally reconstructed computed tomography scan of the lumbar spine shows a defect of the pars interarticularis on the left at L5.
Lumbar oblique radiograph showing the "Scotty dog." A pars defect is seen at L5.
 
 
 
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