# Cervical Spondylosis - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: NICE Clinical Knowledge Summaries: Cervical radiculopathy 2021 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Tizanidine hydrochloride tablets US prescribing information (DailyMed, Dr. Reddy's) · Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762) - Verified date: 2026-08 ## Verified against - Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) - MSF Essential Drugs 2024 - paracetamol (oral) - Tizanidine hydrochloride tablets US prescribing information (DailyMed, Dr. Reddy's) - Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762) - Cervical Spondylosis - disease-level clinical article (cervical-spondylosis-clinical.txt) ## Treatment metadata - Ibuprofen — 400 mg — oral.solid - Referral & safety-netting (no drug therapy) - Pregabalin — 75 mg — oral.solid - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text CERVICAL SPONDYLOSIS Sources: NICE Clinical Knowledge Summaries: Cervical radiculopathy 2021 · Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) · MSF Essential Drugs 2024 - paracetamol (oral) · Tizanidine hydrochloride tablets US prescribing information (DailyMed, Dr. Reddy's) · Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762) Review status: REVIEWED against Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560), MSF Essential Drugs 2024 - paracetamol (oral), Tizanidine hydrochloride tablets US prescribing information (DailyMed, Dr. Reddy's), Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762), Cervical Spondylosis - disease- level clinical article (cervical-spondylosis-clinical.txt) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (9) - Neck stiffness and pain are worst when upright and ease with lying down [neck stiffness] - Extending or bending the neck to the side typically makes the pain worse - Pain can radiate behind the ear with upper cervical disease, or to the trapezius and periscapular region with lower disease - Jaw or chest pain can be an atypical, angina-like presentation of neck disease [chest pain · jaw pain] - Radicular symptoms follow a myotomal pattern with neck, arm and scapular pain plus paresthesia and hand weakness [tingling] - Hand clumsiness that interferes with fine tasks like buttoning a shirt can be an early myelopathy clue - Unsteady gait and unexplained falls are frequently described - Bladder symptoms are uncommon and only show up late in the disease course - A sensation of heavy legs is described as the one early clue linked to faster diagnosis SIGNS - what you find (9) - Exam often shows a stiff, immobile neck with tender trigger points in the trapezius and paraspinal muscles - A positive Spurling test reproduces arm pain when the head is extended and turned toward the painful side - A positive Lhermitte sign - shock-like sensations down the spine on neck flexion - raises concern for degenerative myelopathy [shock] - The Hoffman sign - reflexive thumb or index flexion when the fingertip is flicked - is a more specific myelopathy finding - A positive Romberg test, worse balance with the eyes shut, points to dorsal column dysfunction - Upper motor neuron findings such as spasticity, hyperreflexia, sustained clonus or an extensor Babinski suggest cord compromise [hyperreflexia · spasticity] - A patient can normally open and close a fist about 20 times in 10 seconds on the grip-and- release test - The Tromner reflex and general hyperreflexia are the most sensitive bedside findings for myelopathy [hyperreflexia] - Highly specific bedside findings include the inverted supinator sign, Babinski, Tromner and clonus TESTS (9) - Plain x-rays are a reasonable first imaging test, though findings correlate poorly with pain severity - X-rays typically show osteophytes, disc space narrowing, endplate sclerosis and facet joint changes - A Torg-Pavlov ratio under 0.8 signals cervical canal stenosis, versus a normal value of 1 - MRI is the gold-standard study for assessing neural structures and soft tissue - CT defines bone detail clearly and beats plain films for assessing foraminal narrowing - CT myelography is an option when MRI is contraindicated, such as with a pacemaker, or prior hardware causes artifact - EMG helps separate nerve root compression from peripheral neuropathies and other neuromuscular disease - A 2011 study found the Spurling test 95% sensitive and 94% specific for nerve root pathology against CT or MRI - Flexion-extension MRI can uncover dynamic canal narrowing that a standard neutral-position scan misses IF NOT THIS - what else fits (8) - Cervical sprain, strain, facet arthropathy or myofascial trigger points cause axial pain without dermatomal spread and a normal neuro exam - Shoulder pathology such as glenohumeral arthritis or rotator cuff disease causes overhead- aggravated lateral shoulder pain with a negative Spurling test - Carpal tunnel syndrome causes nighttime thumb, index and middle finger paresthesia with preserved neck motion - Cubital tunnel syndrome causes weak intrinsic hand muscles with numb fourth and fifth fingers, while sensation over the ulnar forearm stays normal, unlike a C8 root problem - Brachial neuritis starts as acute shoulder pain followed by patchy weakness not tied to a single nerve root - Thoracic outlet compression causes positional arm fatigue that eases once the shoulder is lowered - Fracture, epidural abscess, osteomyelitis or metastatic tumor should be excluded when pain is constant, nocturnal or comes with fever or weight loss - Multiple sclerosis, B12 deficiency, ALS and Guillain-Barre syndrome can mimic myelopathy without matching cord compression on scans Source StatPearls "Cervical Spondylosis" - disease-level clinical article Status traced to the source above 1. IBUPROFEN [1st line] Adult 400 mg orally three times daily with or after food - Short-term use only; consult a doctor if required for more than 10 days Peds Cervical spondylosis is a chronic degenerative spine disease of adults; pediatric spinal pathology requires specialist pediatric orthopedic evaluation. Source Ibuprofen 100 mg/5 ml SmPC section 4.2 (eMC product 4560) Why Non-selective NSAID used first-line to control the inflammatory and mechanical pain of cervical spondylosis by blocking prostaglandin synthesis. Caution Use the lowest effective dose for the shortest duration necessary to minimize gastrointestinal, renal, and cardiovascular risks. Contraindicated in active peptic ulcer disease, severe heart failure, advanced renal impairment, or third trimester of pregnancy. Co-prescribe a proton pump inhibitor (e.g. omeprazole) in elderly patients (>65 years) or those with gastrointestinal risk factors. Egypt DAJUANOFEN 400 MG 20 F.C. TABS. COPAD PHARMA 5.00 EGP (0.25/unit) FLABU 400MG 10 F.C.TAB. DELTA PHARMA 3.75 EGP (0.38/unit) NOVA-PROFEN 400MG 30 F.C. TABLETS SANOFI 12.75 EGP (0.42/unit) IBUPROFEN 400 MG 10 TAB. SEDICO 6.00 EGP (0.60/unit) MAFO 400 MG 30 F.C.TABS EIPICO 42.00 EGP (1.40/unit) BRUFEN 400 MG 30 TABS. KAHIRA > ABBO... 78.00 EGP (2.60/unit) PROFUSOL 400MG 20 S.G CAPS. EUROPEAN EGYP... 31.00 EGP ANALGIPROF 400 MG 25 SACHETS EVA PHARMA 37.50 EGP NOVA-PROFEN 100MG/5ML ORAL SUSP. 100ML SANOFI 2.25 EGP -> ? strength differs, ? different route - not oral solid BRUFEMOL-N SUSP. 60 ML ARAB DRUG COM... 4.50 EGP -> ? strength differs, ? different route - not oral solid 2. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Cervical Spondylosis - disease-level clinical article (cervical-spondylosis- clinical.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution The red flags requiring urgent evaluation are severe or rapidly progressing neurological deficits, bowel or bladder dysfunction, and unexplained weight loss. 3. PREGABALIN [2nd line] Adult 150 mg/day to start, given as 75 mg twice daily. If response and tolerability allow, increase to 300 mg/day (150 mg twice daily) after an interval of 3 to 7 days, and if needed to the maximum 600 mg/day (300 mg twice daily) after a further 7 days. Reduce the dose in renal impairment. - Ongoing evaluation Peds Not indicated for degenerative neck pain in pediatric patients. Source Alzain 75 mg Capsules, Hard SmPC section 4.2 Posology and method of administration (eMC product 1762) Why Second-line agent used when cervical spondylosis produces neuropathic arm pain from nerve root compression (cervical radiculopathy); it dampens abnormal nerve signalling rather than treating the underlying joint disease. Caution Indicated as second-line therapy when cervical spondylosis is accompanied by neuropathic arm pain (cervical radiculopathy). May cause significant dizziness, somnolence, peripheral edema, gait disturbance, and weight gain; counsel on driving impairment. Requires gradual dose reduction over at least 1 week when discontinuing to avoid withdrawal symptoms; reduce dose in renal impairment. NG59's instruction not to offer gabapentinoids is about sciatica and low back pain - the lumbar spine. It does not cover the cervical spine, and pregabalin here rests on CG173 for neuropathic pain instead. Worth knowing, because the sciatica entry does not offer pregabalin on that NG59 recommendation, and the two entries look inconsistent until you know the scopes differ. The label opens by telling you to agree an exit plan with the patient BEFORE the first dose: pregabalin causes dependence, addiction and a withdrawal syndrome, and treatment should be given for the shortest possible duration (Alzain SmPC sections 4.2 and 4.4). Egypt FORPREGAB 75 MG 30 CAPS. GRAND PHARMA ... 45.00 EGP (1.50/unit) SNAPGAB 75 MG 30 CAPS. MASH PREMIERE... 49.50 EGP (1.65/unit) LYRIBALIN 75MG 10 CAPS. BORG 18.00 EGP (1.80/unit) NEURAGABALIN 75 MG 10 CAPS. DELTA GRAND P... 23.00 EGP (2.30/unit) NERVATYCA 75 MG 20 CAPS. ALFACURE PHAR... 48.75 EGP (2.44/unit) QUEENLEPT 75 MG 30 CAPS. FUTURE PHARMA... 93.00 EGP (3.10/unit) LYRICA 75MG 20 CAPS. PFIZER 232.00 EGP (11.60/unit) PREGABEDIUM 75 MG 20 H.G. CAPS. SABAA > ACTIV... 56.66 EGP LOCIKASWAB 100MG/5ML 20 UNIDOSE ORAL SOLN. UNISWAB > VODACHEM 43.50 EGP -> ? strength differs, ? different route - not oral solid AVEROPREG 100MG/5ML SYRUP 60 ML AVERROES PHAR... 55.50 EGP -> ? strength differs, ? different route - not oral solid 4. PARACETAMOL [add-on - not a substitute] Adult 500-1000 mg orally three or four times a day PRN for neck pain (max 4000 mg/day) - PRN during painful flares Peds Degenerative condition of adults; not applicable in pediatric populations. Source MSF Essential Drugs 2024 - paracetamol (oral) Why Adjunct analgesic added to NSAID therapy for extra pain control in cervical spondylosis; works centrally rather than through an anti-inflammatory action and does not replace the NSAID. Caution Do not exceed 4000 mg per day total paracetamol from all combined medications to avoid severe hepatotoxicity. Use caution in chronic alcohol dependency, malnutrition, or severe hepatic impairment. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)