NONSTEROIDAL ANTI-INFLAMMATORY DRUGS IN THE MANAGEMENT OF DEGENERATIVE SPINAL DISORDERS: EFFICACY, SAFETY, AND FUTURE PERSPECTIVES

Abstract

Objective. To analyze the current literature on the pathogenetically justified use of nonsteroidal anti-inflammatory drugs (NSAIDs) in patients with degenerative spinal diseases, considering the growing use of this drug class in recent years during the perioperative period of spinal surgery as well as in conservative treatment, and to identify potential risks and prospects for optimizing therapy. Methods. A literature review was conducted using electronic databases such as PubMed, covering the past 10 years. Results. Relevant studies were selected that highlight the pathogenesis of degenerative spinal disorders (DSD), the role of inflammatory mediators, the mechanisms of NSAID action, and their impact on pain and inflammation. The key role of inflammatory processes in intervertebral disc degeneration was emphasized, with increased expression of cytokines IL-1β, TNF-α, and IL-6. This cascade promotes extracellular matrix degradation, triggers neurovascular ingrowth, and enhances nociceptive sensitization. Comparative clinical trials demonstrate that NSAIDs with varying degrees of cyclooxygenase isoform selectivity reduce pain scores and improve functional outcomes, though they differ in tolerability profiles. For chronic use, special attention is required regarding gastrointestinal and cardiovascular risk assessment, minimal effective dosing, and the use of protective co-medications. Conclusion. Accumulating experimental evidence suggests that NSAIDs should be regarded not only as symptomatic analgesics but also as potential modulators of the inflammatory microenvironment of the intervertebral disc. This opens perspectives for their combination with biological agents or antioxidants to slow down the degenerative process. Future research should focus on developing personalized treatment protocols integrating pharmacological, physical, and rehabilitative interventions with consideration of inflammatory biomarkers.