Medication Summary
The goal of pharmacotherapy is to reduce morbidity and prevent complications.
Nonsteroidal anti-inflammatory drugs
Class Summary
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.
Naproxen (Anaprox, Naprelan, Naprosyn, Aleve)
Relieves mild to moderately severe pain and inhibits inflammatory reactions, probably by decreasing the activity of the enzyme cyclooxygenase, thus inhibiting prostaglandin synthesis.
Ibuprofen (Ibuprin, Advil, Motrin)
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).
Indomethacin (Indocin, Indochron E-R)
Rapidly absorbed; metabolism occurs in the liver by demethylation, deacetylation, and glucuronide conjugation. Indomethacin inhibits prostaglandin synthesis.
Piroxicam (Feldene)
Decreases the activity of cyclooxygenase, which in turn inhibits prostaglandin synthesis; piroxicam's effects decrease the formation of inflammatory mediators.
Aspirin (Anacin, Ascriptin, Bayer Aspirin)
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 (Mobic, Vivlodex)
Meloxicam has anti-inflammatory effects systemically and can reduce the effect of local inflammatory mediators.
Corticosteroids
Class Summary
Corticosteroids have potent anti-inflammatory properties. These medications can be given as a brief tapered course of oral treatment.
Prednisone (Deltasone, Orasone, Sterapred)
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
Class Summary
Muscle relaxants are used to treat muscle spasm, which may play a role in patient discomfort.
Methocarbamol (Robaxin)
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.
Antidepressants
Class Summary
These agents are useful in select cases of chronic pain.
Amitriptyline (Elavil)
Antidepressant with sedative effects. The mechanism of action is unknown. Amitriptyline is not an MAOI and does not act primarily by stimulating CNS.
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A cervical myelogram shows advanced spondylotic changes and multiple compression of the spinal cord by osteophytes.
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A 59-year-old woman presented with a spastic gait and weakness in her upper extremities. A T2-weighted sagittal magnetic resonance imaging scan shows 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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A T2-weighted cervical magnetic resonance imaging scan shows obliteration of the subarachnoid space as a result of spondylotic changes.
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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. An axial, gradient-echo magnetic resonance imaging scan 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).
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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. A T2-weighted sagittal magnetic resonance imaging scan shows ventral osteophytosis, most prominent between C4 and C7, with reduction of the ventral cerebrospinal fluid sleeve.
