′Only fixation′ as rationale treatment for spinal canal stenosis

Letter to the Editor: Retro-odontoid mass

“…5,6 Accordingly, we suggested that facetal distraction and fixation or only fixation of the spinal segments may be the optimum form of treatment in degenerative spinal disease. 2,10,11,15,18,19,23,25 We speculated that there may be no need for direct removal of the osteophyte. 8 We reported our results of facetal fixation with or without facetal distraction and fixation for degenerative diseases involving the craniovertebral junction and the subaxial spine.…”

“…8 We reported our results of facetal fixation with or without facetal distraction and fixation for degenerative diseases involving the craniovertebral junction and the subaxial spine. 10,11,[23][24][25] Along similar lines, we have suggested that instability is the primary nodal point of the pathogenesis of OPLL meriting the need for stabilization of the spine and that there is no need to directly handle or resect OPLL. 7,14,20 In RA, the disease of the lateral mass is more pronounced, and the joint arthritis affecting the articular cartilage and facetal bone destruction can lead to lateral mass collapse resulting in mild to severe reduction in its height.…”

“…1,12,13 However, some reports have stated that retro-odontoid pseudotumors are not always associated with obvious atlantoaxial instability. 2,3,10 Chikuda et al 2 reported that a retro-odontoid mass reduction occurred after posterior fusion even in the absence of radiographic atlantoaxial instability.…”

Degenerative Cervical Spondylosis- Is Instability the Primary Point of Pathogenesis?

“…Essentially it means that there is no need to remove the osteophytes, thickened ligaments or protruding disc bulge to affect restoration of the cord shape, it is essential to stop the abnormal movements by stabilization. We have now realized that 'only fixation' of the facets or the site of spinal movements is an ideal form of treatment for degeneration of spine [12][13][14]. We prefer transarticular facetal fixation [15,16].…”

Relevance of Goel′s hypothesis regarding pathogenesis of degenerative spondylosis and its implications on facet distraction surgery

“…Instead, Goel's hypothesis of pathogenesis of spondylosis places the entire onus on incompetence or weakness of muscles that are responsible for standing human position and on “vertical” instability of the spine. [123] The hypothesis that is the basis of Goel's facetal distraction surgery described in 2011 as a form of treatment of degenerative spine is based on the fact that muscle weakness due to varying factors leading to instability and telescoping of the vertebral elements appears to be primary factor in the entire process of degeneration. [45] Accordingly, instability could be the primary factor in the pathogenesis of degenerative spondylosis and secondary “pathologic” spondylotic changes of disk, bones, and ligaments.…”