Clinical evolution in the treatment of degenerative cervical myelopathy in Japan: excellence born from necessity

To commemorate the centennial of the Japanese Orthopaedic Association, this review highlights Japan's pioneering and globally impactful contributions to spinal surgery, focusing specifically on degenerative cervical myelopathy (DCM) as a representative field of clinical excellence born from unique demographic needs.

A comprehensive historical and clinical overview was conducted, tracing the evolutionary path of diagnostic paradigms and posterior decompressive techniques developed by Japanese innovators, driven by a high domestic prevalence of developmental canal stenosis and ossification of the posterior longitudinal ligament (OPLL).

In the pre-MRI era, clinical necessity fostered a rigorous neurological culture, yielding diagnostic landmarks such as the Hattori classification, the ten second test, and precise level diagnosis criteria. To circumvent the catastrophic complications of conventional laminectomy, Japanese spine surgeons revolutionized global practice by inventing laminoplasty, evolving from Hattori's Z-plasty to Hirabayashi's open-door and Kurokawa's double-door techniques. Recent decades have seen these procedures meticulously refined to preserve cervical alignment and musculature, successfully adapting to an unprecedented super-aged population.

As epitomized by the historical breakthroughs in DCM, Japanese spinal innovations have long established universal standards in patient care. At the forefront of a rapidly aging global population, Japanese orthopaedic surgeons remain uniquely positioned to spearhead the next frontier of clinical innovation across the broader field of spinal care.