Osteophyte formation in the vertebral column is a well documented phenomenon that is poorly understood. The most commonly identified etiologic factors are degeneration and altered mechanics of the spine, either of which in turn have been considered to be a result of the natural aging process or the pathogenesis of spinal disease. In Part I [Contemporary Orthopaedics, 29(1): 31-37, 1994], the process of osteophyte formation was reviewed. In Part II, the sequential and consequential changes from the finely interwoven events of aging, degeneration, mechanical instability, and disease are described.