Sections

Diagnosis and Management of Cervical Spondylosis

Sections Diagnosis and Management of Cervical Spondylosis
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
References

Medication

Medication Summary

The goal of pharmacotherapy is to reduce pain and inflammation.

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)

View full drug information

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

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

View full drug information

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

Diclofenac (Voltaren)

View full drug information

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)

View full drug information

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

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

View full drug information

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

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)

View full drug information

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)

View full drug information

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.

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)

View full drug information

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.

Class Summary

Reduce associated cervical muscle spasm.

Carisoprodol (Soma)

View full drug information

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

Cyclobenzaprine (Flexeril)

View full drug information

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)

View full drug information

Drug combination indicated for moderately severe to severe pain.

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

View full drug information

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

Questions

Parke WW. Correlative anatomy of cervical spondylotic myelopathy. Spine (Phila Pa 1976). 1988 Jul. 13(7):831-7. [QxMD MEDLINE Link].
McCormack BM, Weinstein PR. Cervical spondylosis. An update. West J Med. 1996 Jul-Aug. 165(1-2):43-51. [QxMD MEDLINE Link].
Wilkinson M. The morbid anatomy of cervical spondylosis and myelopathy. Brain. 1960 Dec. 83:589-617. [QxMD MEDLINE Link].
Hoff JT, Wilson CB. The pathophysiology of cervical spondylotic radiculopathy and myelopathy. Clin Neurosurg. 1977. 24:474-87. [QxMD MEDLINE Link].
Rosomoff HL, Fishbain D, Rosomoff RS. Chronic cervical pain: radiculopathy or brachialgia. Noninterventional treatment. Spine (Phila Pa 1976). 1992 Oct. 17(10 Suppl):S362-6. [QxMD MEDLINE Link].
Emery SE. Cervical spondylotic myelopathy: diagnosis and treatment. J Am Acad Orthop Surg. 2001 Nov-Dec. 9(6):376-88. [QxMD MEDLINE Link].
Fehlings MG, Skaf G. A review of the pathophysiology of cervical spondylotic myelopathy with insights for potential novel mechanisms drawn from traumatic spinal cord injury. Spine (Phila Pa 1976). 1998 Dec 15. 23(24):2730-7. [QxMD MEDLINE Link].
Young WF. Cervical spondylotic myelopathy: a common cause of spinal cord dysfunction in older persons. Am Fam Physician. 2000 Sep 1. 62(5):1064-70, 1073. [QxMD MEDLINE Link].
McCormick WE, Steinmetz MP, Benzel EC. Cervical spondylotic myelopathy: make the difficult diagnosis, then refer for surgery. Cleve Clin J Med. 2003 Oct. 70(10):899-904. [QxMD MEDLINE Link].
Young WF, Weaver M, Mishra B. Surgical outcome in patients with coexisting multiple sclerosis and spondylosis. Acta Neurol Scand. 1999 Aug. 100(2):84-7. [QxMD MEDLINE Link].
al-Mefty O, Harkey HL, Marawi I, et al. Experimental chronic compressive cervical myelopathy. J Neurosurg. 1993 Oct. 79(4):550-61. [QxMD MEDLINE Link].
Henderson FC, Geddes JF, Vaccaro AR, Woodard E, Berry KJ, Benzel EC. Stretch-associated injury in cervical spondylotic myelopathy: new concept and review. Neurosurgery. 2005 May. 56(5):1101-13; discussion 1101-13. [QxMD MEDLINE Link].
Moore AP, Blumhardt LD. A prospective survey of the causes of non-traumatic spastic paraparesis and tetraparesis in 585 patients. Spinal Cord. 1997 Jun. 35(6):361-7. [QxMD MEDLINE Link].
Holt S, Yates PO. Cervical spondylosis and nerve root lesions. Incidence at routine necropsy. J Bone Joint Surg Br. 1966 Aug. 48(3):407-23. [QxMD MEDLINE Link].
Rahim KA, Stambough JL. Radiographic evaluation of the degenerative cervical spine. Orthop Clin North Am. 1992 Jul. 23(3):395-403. [QxMD MEDLINE Link].
Heller JG. The syndromes of degenerative cervical disease. Orthop Clin North Am. 1992 Jul. 23(3):381-94. [QxMD MEDLINE Link].
Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys Med Rehabil. 1994 Mar. 75(3):342-52. [QxMD MEDLINE Link].
Stoffman MR, Roberts MS, King JT Jr. Cervical spondylotic myelopathy, depression, and anxiety: a cohort analysis of 89 patients. Neurosurgery. 2005 Aug. 57(2):307-13; discussion 307-13. [QxMD MEDLINE Link].
Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury; with special reference to the mechanisms involved in hyperextension injuries of cervical spine. J Neurosurg. 1954 Nov. 11(6):546-77. [QxMD MEDLINE Link].
Kaye JJ, Dunn AW. Cervical spondylotic dysphagia. South Med J. 1977 May. 70(5):613-4. [QxMD MEDLINE Link].
Umerah BC, Mukherjee BK, Ibekwe O. Cervical spondylosis and dysphagia. J Laryngol Otol. 1981 Nov. 95(11):1179-83. [QxMD MEDLINE Link].
Sobol SM, Rigual NR. Anterolateral extrapharyngeal approach for cervical osteophyte-induced dysphagia. Literature review. Ann Otol Rhinol Laryngol. 1984 Sep-Oct. 93(5 Pt 1):498-504. [QxMD MEDLINE Link].
Farooqi NA, Doran M, Buxton N. Cervical osteophytes: a cause of potentially life-threatening laryngeal spasms. Case report. J Neurosurg Spine. 2006 May. 4(5):419-20. [QxMD MEDLINE Link].
Kanbay M, Selcuk H, Yilmaz U. Dysphagia caused by cervical osteophytes: a rare case. J Am Geriatr Soc. 2006 Jul. 54(7):1147-8. [QxMD MEDLINE Link].
Teresi LM, Lufkin RB, Reicher MA, et al. Asymptomatic degenerative disk disease and spondylosis of the cervical spine: MR imaging. Radiology. 1987 Jul. 164(1):83-8. [QxMD MEDLINE Link].
Brown BM, Schwartz RH, Frank E, Blank NK. Preoperative evaluation of cervical radiculopathy and myelopathy by surface-coil MR imaging. AJR Am J Roentgenol. 1988 Dec. 151(6):1205-12. [QxMD MEDLINE Link].
Alexander JT. Natural history and nonoperative management of cervical spondylosis. In: Menezes AH, Sonntag VKH, et al. Principles of Spinal Surgery. Vol 1. 1996:547-557.
Penning L, Wilmink JT, van Woerden HH, Knol E. CT myelographic findings in degenerative disorders of the cervical spine: clinical significance. AJR Am J Roentgenol. 1986 Apr. 146(4):793-801. [QxMD MEDLINE Link].
Yamazaki T, Suzuki K, Yanaka K, Matsumura A. Dynamic computed tomography myelography for the investigation of cervical degenerative disease. Neurol Med Chir (Tokyo). 2006 Apr. 46(4):210-5; discussion 215-6. [QxMD MEDLINE Link].
Song T, Chen WJ, Yang B, et al. Diffusion tensor imaging in the cervical spinal cord. Eur Spine J. 2011 Mar. 20(3):422-8. [QxMD MEDLINE Link].
Iwabuchi M, Kikuchi S, Sato K. Pathoanatomic investigation of cervical spondylotic myelopathy. Fukushima J Med Sci. 2004 Dec. 50(2):47-54. [QxMD MEDLINE Link].
Gore DR, Sepic SB, Gardner GM, Murray MP. Neck pain: a long-term follow-up of 205 patients. Spine (Phila Pa 1976). 1987 Jan-Feb. 12(1):1-5. [QxMD MEDLINE Link].
AGS Panel on Persistent Pain in Older Persons. The management of of persistent pain in older persons. J Am Geriatr Soc. 2002. 50(Suppl 6):S205-S224.
Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehabil. 1999 Jan-Feb. 78(1):30-2. [QxMD MEDLINE Link].
Kaiser MG, Haid RW, Subach BR, Barnes B, Rodts GE Jr. Anterior cervical plating enhances arthrodesis after discectomy and fusion with cortical allograft. Neurosurgery. Feb-2002. 50:229-236.
Baskin DS, Ryan P, Sonnta V, Westmark R, Wedmayer MA. A prospective, randomized, controlled cervical fusion study using recombinant human bone morphogentic protein-2 with the CORNERSTONE-SR allograft ring and the ATLANTIS anterior cervical plate. Spine. 2003. 28:1219-1225.
Rowland LP. Surgical treatment of cervical spondylotic myelopathy: time for a controlled trial. Neurology. 1992 Jan. 42(1):5-13. [QxMD MEDLINE Link].
Nurick S. The natural history and the results of surgical treatment of the spinal cord disorder associated with cervical spondylosis. Brain. 1972. 95(1):101-8. [QxMD MEDLINE Link].
Fouyas IP, Statham PF, Sandercock PA. Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine (Phila Pa 1976). 2002 Apr 1. 27(7):736-47. [QxMD MEDLINE Link].
Kadanka Z, Mares M, Bednaník J, et al. Approaches to spondylotic cervical myelopathy: conservative versus surgical results in a 3-year follow-up study. Spine (Phila Pa 1976). 2002 Oct 15. 27(20):2205-10; discussion 2210-1. [QxMD MEDLINE Link].
Sampath P, Bendebba M, Davis JD, Ducker TB. Outcome of patients treated for cervical myelopathy. A prospective, multicenter study with independent clinical review. Spine (Phila Pa 1976). 2000 Mar 15. 25(6):670-6. [QxMD MEDLINE Link].
Ma X, Zhao XF, Zhao YB. [A clinical study on different decompression methods in cervical spondylosis]. Zhonghua Wai Ke Za Zhi. 2009 Apr 15. 47(8):607-9. [QxMD MEDLINE Link].
Lee JY, Sharan A, Baron EM, et al. Quantitative prediction of spinal cord drift after cervical laminectomy and arthrodesis. Spine (Phila Pa 1976). 2006 Jul 15. 31(16):1795-8. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Kaminsky SB, Clark CR, Traynelis VC. Operative treatment of cervical spondylotic myelopathy and radiculopathy. A comparison of laminectomy and laminoplasty at five year average follow-up. Iowa Orthop J. 2004. 24:95-105. [QxMD MEDLINE Link].
Grob D. Surgery in the degenerative cervical spine. Spine (Phila Pa 1976). 1998 Dec 15. 23(24):2674-83. [QxMD MEDLINE Link].
Kumar VG, Rea GL, Mervis LJ, McGregor JM. Cervical spondylotic myelopathy: functional and radiographic long-term outcome after laminectomy and posterior fusion. Neurosurgery. 1999 Apr. 44(4):771-7; discussion 777-8. [QxMD MEDLINE Link].
Houten JK, Cooper PR. Laminectomy and posterior cervical plating for multilevel cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament: effects on cervical alignment, spinal cord compression, and neurological outcome. Neurosurgery. 2003 May. 52(5):1081-7; discussion 1087-8. [QxMD MEDLINE Link].
Huang RC, Girardi FP, Poynton AR, Cammisa Jr FP. Treatment of multilevel cervical spondylotic myeloradiculopathy with posterior decompression and fusion with lateral mass plate fixation and local bone graft. J Spinal Disord Tech. 2003 Apr. 16(2):123-9. [QxMD MEDLINE Link].
Chagas H, Domingues F, Aversa A, Vidal Fonseca AL, de Souza JM. Cervical spondylotic myelopathy: 10 years of prospective outcome analysis of anterior decompression and fusion. Surg Neurol. 2005. 64 Suppl 1:S1:30-5; discussion S1:35-6. [QxMD MEDLINE Link].
Chibbaro S, Benvenuti L, Carnesecchi S, et al. Anterior cervical corpectomy for cervical spondylotic myelopathy: experience and surgical results in a series of 70 consecutive patients. J Clin Neurosci. 2006 Feb. 13(2):233-8. [QxMD MEDLINE Link].
Macdonald RL, Fehlings MG, Tator CH, et al. Multilevel anterior cervical corpectomy and fibular allograft fusion for cervical myelopathy. J Neurosurg. 1997 Jun. 86(6):990-7. [QxMD MEDLINE Link].
Santiago P, Fessler RG. Minimally Invasive Surgery for the Management of cervical spondylosis. Neurosurgery. Jan-2007. 60:S1-160-165.
Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion: clinical and radiographic results of a randomized, controlled, clinical trial. Spine (Phila Pa 1976). 2009 Jan 15. 34(2):101-7. [QxMD MEDLINE Link].
Razack N, Greenberg J, Green BA. Surgery for cervical myelopathy in geriatric patients. Spinal Cord. 1998 Sep. 36(9):629-32. [QxMD MEDLINE Link].
Murphey F, Simmons JC, Brunson B. Chapter 2. Ruptured cervical discs, 1939 to 1972. Clin Neurosurg. 1973. 20:9-17. [QxMD MEDLINE Link].
Whitecloud TS 3rd, Seago RA. Cervical discogenic syndrome. Results of operative intervention in patients with positive discography. Spine (Phila Pa 1976). 1987 May. 12(4):313-6. [QxMD MEDLINE Link].
Bracken MB, Shepard MJ, Collins WF Jr, et al. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second National Acute Spinal Cord Injury Study. J Neurosurg. 1992 Jan. 76(1):23-31. [QxMD MEDLINE Link].
Chesnut RM, Abitbol JJ, Garfin SR. Surgical management of cervical radiculopathy. Indication, techniques, and results. Orthop Clin North Am. 1992 Jul. 23(3):461-74. [QxMD MEDLINE Link].
Chiles BW 3rd, Leonard MA, Choudhri HF, Cooper PR. Cervical spondylotic myelopathy: patterns of neurological deficit and recovery after anterior cervical decompression. Neurosurgery. 1999 Apr. 44(4):762-9; discussion 769-70. [QxMD MEDLINE Link].
Clarke E, Robinson PK. Cervical myelopathy: a complication of cervical spondylosis. Brain. 1956 Sep. 79(3):483-510. [QxMD MEDLINE Link].
Clements DH, O'Leary PF. Anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 1990 Oct. 15(10):1023-5. [QxMD MEDLINE Link].
Connor PM, Darden BV 2nd. Cervical discography complications and clinical efficacy. Spine (Phila Pa 1976). 1993 Oct 15. 18(14):2035-8. [QxMD MEDLINE Link].
Cull R, Whittle I. The nervous system. Munro J, Edwards CS. Macleod's Clinical Examination. 1995. 201-256.
Denno JJ, Meadows GR. Early diagnosis of cervical spondylotic myelopathy. A useful clinical sign. Spine (Phila Pa 1976). 1991 Dec. 16(12):1353-5. [QxMD MEDLINE Link].
Dillin W, Booth R, Cuckler J, Balderston R, Simeone F, Rothman R. Cervical radiculopathy. A review. Spine (Phila Pa 1976). 1986 Dec. 11(10):988-91. [QxMD MEDLINE Link].
Dillin W, Uppal GS. Analysis of medications used in the treatment of cervical disk degeneration. Orthop Clin North Am. 1992 Jul. 23(3):421-33. [QxMD MEDLINE Link].
Durufle A, Petrilli S, Le Guiet JL, et al. Cervical spondylotic myelopathy in athetoid cerebral palsy patients: about five cases. Joint Bone Spine. 2005 May. 72(3):270-4. [QxMD MEDLINE Link].
Ebara S, Yonenobu K, Fujiwara K, Yamashita K, Ono K. Myelopathy hand characterized by muscle wasting. A different type of myelopathy hand in patients with cervical spondylosis. Spine (Phila Pa 1976). 1988 Jul. 13(7):785-91. [QxMD MEDLINE Link].
Firooznia H, Ahn JH, Rafii M, Ragnarsson KT. Sudden quadriplegia after a minor trauma. The role of preexisting spinal stenosis. Surg Neurol. 1985 Feb. 23(2):165-8. [QxMD MEDLINE Link].
Goodridge AE, Feasby TE, Ebers GC, Brown WF, Rice GP. Hand wasting due to mid-cervical spinal cord compression. Can J Neurol Sci. 1987 Aug. 14(3):309-11. [QxMD MEDLINE Link].
Haerer AF. Examination in cases of suspected hysteria and malingering. DeJong's The Neurologic Examination. 5th ed. 1992. 744.
Haldeman S, Kohlbeck FJ, McGregor M. Risk factors and precipitating neck movements causing vertebrobasilar artery dissection after cervical trauma and spinal manipulation. Spine (Phila Pa 1976). 1999 Apr 15. 24(8):785-94. [QxMD MEDLINE Link].
Irvine DH, Foster JB, Newell DJ, Klukvin BN. Prevalence of cervical spondylosis in a general practice. Lancet. 1965 May 22. 14:1089-92. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Kaiser JA, Holland BA. Imaging of the cervical spine. Spine (Phila Pa 1976). 1998 Dec 15. 23(24):2701-12. [QxMD MEDLINE Link].
LaBan MM, Taylor RS. Manipulation: an objective analysis of the literature. Orthop Clin North Am. 1992 Jul. 23(3):451-9. [QxMD MEDLINE Link].
Lam M. Headache. Adler SN, et al. A Pocket manual of Differential Diagnosis. 1994. 303-304.
LaRocca H. Cervical spondylotic myelopathy: natural history. Spine (Phila Pa 1976). 1988 Jul. 13(7):854-5. [QxMD MEDLINE Link].
Lees F, Turner J. Natural history and prognosis of cervical spondylosis. BMJ. 1963. 2:1603.
Nakano KK. Neck pain. Kelley WN, Harris ED, Ruddy S, Sledge CB. Textbook of Rheumatology. 1985. 471-490.
Ono K, Ebara S, Fuji T, Yonenobu K, Fujiwara K, Yamashita K. Myelopathy hand. New clinical signs of cervical cord damage. J Bone Joint Surg Br. 1987 Mar. 69(2):215-9. [QxMD MEDLINE Link].
Papadopoulos SM, Hoff JT. Anatomical treatment of cervical spondylosis. Clin Neurosurg. 1994. 41:270-85. [QxMD MEDLINE Link].
Phillips DG. Surgical treatment of myelopathy with cervical spondylosis. J Neurol Neurosurg Psychiatry. 1973 Oct. 36(5):879-84. [QxMD MEDLINE Link]. [Full Text].
Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985 Aug. 63(2):278-82. [QxMD MEDLINE Link].
Robinson R, Smith G. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp. 1955. 96:223.
Saunders R. Corpectomy for cervical spondylotic myelopathy. Menezes AH, Sonntag VH, et al. Principles of Spinal Surgery. 1996. Vol. 1: 559-569.
Schellhas KP, Smith MD, Gundry CR, Pollei SR. Cervical discogenic pain. Prospective correlation of magnetic resonance imaging and discography in asymptomatic subjects and pain sufferers. Spine (Phila Pa 1976). 1996 Feb 1. 21(3):300-11; discussion 311-2. [QxMD MEDLINE Link].
Tan JC, Nordin M. Role of physical therapy in the treatment of cervical disk disease. Orthop Clin North Am. 1992 Jul. 23(3):435-49. [QxMD MEDLINE Link].
Verbiest H. Chapter 23. The management of cervical spondylosis. Clin Neurosurg. 1973. 20:262-94. [QxMD MEDLINE Link].
Viikari-Juntura E, Porras M, Laasonen EM. Validity of clinical tests in the diagnosis of root compression in cervical disc disease. Spine (Phila Pa 1976). 1989 Mar. 14(3):253-7. [QxMD MEDLINE Link].
Watson JC, Broaddus WC, Smith MM, Kubal WS. Hyperactive pectoralis reflex as an indicator of upper cervical spinal cord compression. Report of 15 cases. J Neurosurg. 1997 Jan. 86(1):159-61. [QxMD MEDLINE Link].
Yoo K, Origitano TC. Familial cervical spondylosis. Case report. J Neurosurg. 1998 Jul. 89(1):139-41. [QxMD MEDLINE Link].
Yoss RE, Corbin KB, Maccarty CS, Love JG. Significance of symptoms and signs in localization of involved root in cervical disk protrusion. Neurology. 1957 Oct. 7(10):673-83. [QxMD MEDLINE Link].

Media Gallery

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.

of 4

Author

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 Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, American College of International Physicians, American College of Physicians, American Heart Association, American Stroke Association, National Association of Managed Care 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.

Acknowledgements

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.

Sections Diagnosis and Management of Cervical Spondylosis
Overview
Presentation
- History
- Physical
- Causes
- Show All
DDx
Workup
Treatment
Medication
Questions & Answers
Media Gallery
References

Diagnosis and Management of Cervical Spondylosis Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs

Class Summary

Ibuprofen (Motrin, Advil, Haltran, Nuprin)

Ibuprofen (Motrin, Advil, Haltran, Nuprin)

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

Diclofenac (Voltaren)

Diclofenac (Voltaren)

Corticosteroids

Class Summary

Prednisone (Sterapred)

Prednisone (Sterapred)

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

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

Tricyclic antidepressants

Class Summary

Amitriptyline (Elavil)

Amitriptyline (Elavil)

Nortriptyline (Aventyl hydrochloride, Pamelor)

Nortriptyline (Aventyl hydrochloride, Pamelor)

Cyclooxygenase 2 inhibitors

Class Summary

Celecoxib (Celebrex)

Celecoxib (Celebrex)

Muscle relaxants

Class Summary

Carisoprodol (Soma)

Carisoprodol (Soma)

Cyclobenzaprine (Flexeril)

Cyclobenzaprine (Flexeril)

Opiates

Class Summary

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

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

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

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

Diagnosis and Management of Cervical Spondylosis Medication

Medication Summary

Nonsteroidal anti-inflammatory drugs

Class Summary

Ibuprofen (Motrin, Advil, Haltran, Nuprin)

Naproxen (Aleve, Anaprox, Naprelan, Naprosyn)

Diclofenac (Voltaren)

Corticosteroids

Class Summary

Prednisone (Sterapred)

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

Tricyclic antidepressants

Class Summary

Amitriptyline (Elavil)

Nortriptyline (Aventyl hydrochloride, Pamelor)

Cyclooxygenase 2 inhibitors

Class Summary

Celecoxib (Celebrex)

Muscle relaxants

Class Summary

Carisoprodol (Soma)

Cyclobenzaprine (Flexeril)

Opiates

Class Summary

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

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

References

Tables

Contributor Information and Disclosures

What would you like to print?