Muscle Weakness–Related Spinal Instability Is the Cause of Cervical Spinal Degeneration and Spinal Stabilization Is the Treatment: An Experience with 215 Cases Surgically Treated over 7 Years

Clinical outcome following multisegmental cervical spinal fixation in patients who recovered partially following injury

“…[ 18 ] Disc space reduction, osteophyte formation, ligamentum flavum bulging and eventual reduction in spinal canal or neural foraminal girth are secondary and more obvious radiological observations and are indicative of potential or manifest spinal instability. [ 18 19 20 21 ] Despite the fact that instability is the cause, the lateral profile of the facets and location away from neurological structures makes radiological identification of instability difficult or impossible. The identification of unstable spinal segments is done on the basis of clinical and radiological indicators.…”

Is disc herniation “secondary” to spinal instability? Is it a protective natural response?

“…The predominance of extensor muscles located in the back of spine and nape of neck facilitates human standing posture and executes activities of bending, running, jumping, and performing acts of life. However, weakness of these muscles due to their disuse, misuse, or injury can lead to acute or chronic telescoping of the spinal segments or “vertical spinal instability.”[ 2 ] Recent concept is that it is not the age-related reduction in the water content of the disc or disc disease, but it is muscle weakness-related vertical spinal instability that initiates and propels the process of spinal “degeneration.”[ 3 ] Listhesis or telescoping of the facets that form the fulcrum of all spinal movements is the initial consequence of muscle incompetence and all other recognized and the so-called “pathological” events are secondary and probably “protective” natural maneuvers. Our earlier studies have identified that disc space reduction, disc bulges, buckling of posterior longitudinal ligament and ligamentum flavum, and osteophyte formation are processes consequent to vertical spinal instability.…”

“…Our earlier studies have identified that disc space reduction, disc bulges, buckling of posterior longitudinal ligament and ligamentum flavum, and osteophyte formation are processes consequent to vertical spinal instability. [ 3 4 5 6 7 8 9 ] Neck pain, spasm of the muscles of nape of neck or back, and similar such symptoms are an attempt by nature to avoid excessive movements and potential worsening of instability or neural consequences. Vertical spinal instability, muscle spasms, and secondary “pathological” consequences result in reduction in the vertical height of the spinal column and consequent reduction in the dimensions of spinal canal and of intervertebral spinal neural foramina.…”

“…The very fact that surgery that involves “only-fixation” of the involved spinal segments results in immediate postoperative relief from symptoms is a testimony to the concept. [ 3 4 5 6 7 8 9 11 ] Essentially, all the known “pathological” features of spinal degeneration can regress or disappear following such surgery. Our recent studies have identified eventual reduction in the size of osteophytes following a surgical procedure that involves only spinal stabilization.…”

“…We recently proposed that “only fixation” of the involved spinal segments without any manipulation of the herniated disc might be the treatment. [ 3 11 ] We preferred transarticular screw fixation, wherein the fixation is focused at the site of fulcrum of all movements. [ 13 ] Such treatment can be considered to be “internal” arthrodesis and firm stabilization of the spinal segments, a procedure that any kind of external arthrodesis cannot match.…”