The author discusses his personal concepts about the pathogenesis and treatment of degenerative spine. Vertical instability or telescoping of the spine as a result of long duration ‘standing’ human position is the point of genesis of degenerative spinal ‘disease’. Muscle weakness, disuse or abuse and subsequent instability of the spinal segment generate a series of events that are collectively called ‘spinal spondylotic disease’. All these changes are secondary and most probably protective in nature. Treatment lies in stabilization or fixation of the unstable spinal segment. Removal of bone, osteophytes, disc or ligaments can be avoided.