Is it necessary to resect osteophytes in degenerative spondylotic myelopathy?

Byline: Atul. Goel

Osteophytes are commonly referred to as bone spurs that form along the joint margin. In the spine, osteophytes are universally considered to be the principal agents that compress the spinal cord or roots and result in symptoms of radiculopathy and of myelopathy. The primary aim during surgery for degenerative spine has been either removal of osteophyte for direct decompression of the neural structures or indirectly to perform surgical procedures that will increase the spinal canal dimension and reduce the pinching effect of the osteophyte.

Goel hypothesized that the primary event in spinal degeneration is weakness of the muscles of nape of the neck and vertical spinal instability related to standing human position. [sup][1],[2],[3] Ligamentous buckling, disc space reduction, osteophyte formation and spinal canal or root canal size reduction are secondary phenomenon and related to the primary feature of facetal over-riding. It appears that osteophyte formation is not a primary pathological event and is secondary to spinal instability. The instability is "vertical" in nature and its primary or initial pathogenetic effect is evident on the facets that tend to slip over the one inferior to it, the process being labeled as retrolisthesis in the cervical and dorsal spine and facetal over-riding in the lumbar spine. The entire phenomenon of spinal degeneration or spondylosis is based on or initiated by the primary phenomenon of instability. The pathological effects of degeneration in the form of disc space reduction, osteophyte formation, ligamental buckling and spinal and root canal space reduction are all secondary effects related to primary vertical instability. Addressing the primary factor of spinal instability may potentially result in resolution or disappearance of osteophytes. Instability is primary and the rest of the processes are all secondary or may even be protective in nature. The presence of osteophyte by itself suggests the presence of instability and may direct the need for surgical fixation. If surgical...