International Orthopaedics - 2026-08-06 - Journal Article; Review
Clinical evolution in the treatment of degenerative cervical myelopathy in Japan: excellence born from necessity.
Chikuda H
Topics
Key Takeaway
Japanese spine surgeons developed laminoplasty (Hirabayashi open-door, Kurokawa double-door) as a direct response to high domestic OPLL prevalence, establishing techniques now used globally, though no comparative outcome data with specific numbers are reported in this review.
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Summary
This narrative review traces Japan's contributions to DCM diagnosis and surgical management over the past century, framed around the JOA centennial. It documents the evolution from Hattori's Z-plasty through Hirabayashi's open-door and Kurokawa's double-door laminoplasty, driven by high OPLL prevalence and developmental canal stenosis. No original outcome data or pooled statistics are presented; the review is historical and descriptive.
Key Limitation
No patient-level outcome data, complication rates, or comparative effectiveness statistics are presented, making it impossible to draw evidence-based conclusions about technique superiority from this paper alone.
Original Abstract
PURPOSE
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.
METHODS
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).
RESULTS
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.
CONCLUSION
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.