A New Indicator Predicting the Degree of Cord Shift After Posterior Decompression of Cervical Ossification of the Posterior Longitudinal Ligament Extended to the C2 Level and Its Clinical Usefulness.

Aim: To evaluate the usefulness of the rostral line (R-line) as a new index for determining the degree of C2 lamina decompression in the context of ossification of the posterior longitudinal ligament (OPLL) extending to the C2 level.
Material and Methods: The R-line was devised based on the mechanism by which the cord is shifted backward following cervical posterior decompression. According to their R-line status, 36 patients with cervical OPLL extending to the C2 level were divided into two groups of R-line (+) and R-line (?) cases, where the R-line touched the upper half of the posterior C2 lamina in the R-line (+) group and the inferior half of the posterior C2 lamina in the R-line (?) group, respectively.
Results: Eighteen patients were classified as R-line (+) and 18 patients were classified as R-line (?). Total laminectomy of the C2 lamina was more common in the R-line (+) group, while dome-shape C2 laminectomy was more common in the R-line (?) group. All patients requiring reoperation were included in the R-line (+) group. Only the operation type showed a statistically significant difference according to the need for reoperation in the R-line (+) group; specifically, all patients who underwent reoperation in the R-line (+) group had dome-shape C2 laminectomy. It was determined that the risk factor for reoperation in the R-line (+) group was a history of dome-shape C2 laminectomy.
Conclusion: If the R-line touches the upper half of the posterior C2 lamina, total decompression of the C2 lamina should be performed.