Among the variables tested, preoperative neurological status and intramedullary signal intensity were significantly related to neurological outcome. The better the preoperative neurological status was, the better the post-operative neurological outcome. The SI grade on the preoperative T2WI was negatively related to neurological outcome. Hence, the severity of SI change and preoperative neurological status emerged as significant prognostic factors in post-operative CSM.

BackgroundOssification of the posterior longitudinal ligament (OPLL) may increase the risk of spinal cord injury (SCI) with various neurological deficits after minor trauma. However, few studies have investigated the influence of OPLL on neurological outcome after acute cord injury. We examined whether severe spinal canal stenosis caused by OPLL affects neurological outcome after SCI based on intramedullary signal intensity (SI) changes on magnetic resonance imaging (MRI).MethodsFrom June 2006 to July 2013, we treated 246 patients with cervical cord injury. Fifty-one (20.7 %) patients had ventral cord compression due to OPLL without any bony fractures. Among them, 38 patients (34 men, mean age 62.7 years) underwent cervical laminoplasty (8) and cervical decompression and fixation (30). The neurologic assessments were performed in patients who had 1-year follow-up, and the mean follow-up period was 42.2 months. OPLL type, cause of injury, cervical sagittal angle, cervical spine stenosis, cord compression ratio (space available for the spinal cord (SAC)), and grade of intramedullary SI (grade 0, none; grade 1, light; grade 2, intense T2WI) were assessed.ResultsMean American Spinal Injury Association (ASIA) motor score at admission was 38.4 ± 21.9 (range, 2–70) and improved to 67.7 ± 19.1 (range, 8–94) at last follow-up (p < 0.05). Mean recovery rate of the motor score was 55.8 ± 19.9 %. Five patients had SI grade 0, 20 patients had SI grade 1, and 13 patients had SI grade 2. Among the variables tested, age, initial ASIA motor grade, intramedullary SI grade, and SAC were significantly related to neurological outcome. However, initial cervical alignment, canal diameter, length of SI, time interval between injury and operation, and OPLL type had no significant effect on neurological outcome.ConclusionsPreoperative neurological status, cord compression ratio, and SI grade are related to neurological outcome in patients with SCI associated with OPLL. The better the preoperative neurological status, the more favorable the neurological outcome after surgery. A higher SI grade on preoperative T2WI was negatively related to neurological outcome. Therefore, the severity of SI change, cord compression ratio, and preoperative neurological status can be regarded as significant prognostic factors in patients with SCI associated with OPLL.

Purpose We prospectively investigated whether high intramedullary SI and contrast [gadolinium-diethylenetriamine-pentaacetic acid (Gd-DTPA)] enhancement in magnetic resonance imaging (MRI) are associated with postoperative prognosis in cervical compressive myelopathy (CCM) patients. Methods Seventy-four patients with ventral cord compression at one or two levels underwent anterior cervical discectomy and fusion (ACDF) for CCM between March 2006 and June 2009. The mean follow-up period was 39.7 months (range, 12.7-55.7 months). The cervical cord compression ratio and clinical outcomes were measured using Japanese Orthopedic Association (JOA) scores for cervical myelopathy. Patients were classified into three groups based on the SI change in T2WI, T1-weighted images (T1WI), and contrast (Gd-DTPA) enhancement. Results The mean preoperative and postoperative JOA scores were 10.5 ± 2.9 and 15.0 ± 2.1 (P \ 0.05), respectively. The mean recovery ratio of the JOA score was 70.9 ± 20.2%. There were statistically significant differences in postoperative JOA and recovery ratio among three groups. However, post-surgical neurological outcomes were not associated with age, symptom duration, preoperative JOA, and cord compression. Conclusions We found that intramedullary SI change is a poor prognostic factor and the intramedullary contrast (Gd-DTPA) enhancement on preoperative MRI should be viewed as the worst predictor of surgical outcomes in cervical myelopathy. Contrast (Gd-DTPA) enhancement and postoperative MRI are useful for identifying the prognosis of patients with poor neurological recovery.

The brachiocephalic vein is formed by the internal jugular vein and the subclavian vein. The left brachiocephalic vein (LBCV) usually passes superior and anterior to the aortic arch (1). In rare cases, this vein follows an anomalous course. This anomaly was first described by Kerschner in 1888 (2) and a double LBCV described by Takata in 1992 (3). The incidence of an aberrant left brachiocephalic vein (ALBCV) with congenital heart disease is 0.15-0.98%, whereas in the general population, the incidence of this condition has been reported to be from 0.06 to 0.37% (4). In this report, we describe the computed tomography (CT) findings of circumaortic LBCV. Case ReportA 53-year-old male presented with chest wall pain. He underwent chest CT scan with 5-mm section thicknesses using a multidetector CT scanner (Aquilion 64, Toshiba Medical Systems, Tokyo, Japan). The images were acquired within a single breath hold after injection of the contrast medium (Iobrix 350; injection rate, 2.2 mL/sec; volume, 100 mL).The CT scan revealed lung cancer in the right upper lobe. Incidentally, the CT identified an ALBCV that was divided into two branches at the level of the aortic arch (Fig. 1). The anterior branch was above the aortic arch and coursed anterior to the left common carotid artery and brachiocephalic artery, before draining into the superior vena cava (SVC). The posterior branch was below the aortic arch and coursed posterior to the ascending aorta. Both branches drained into the SVC separately and no other cardiovascular anomaly was noted. The patient refused further evaluation and operation. DiscussionThe brachiocephalic veins are two large vessels at the junction of the neck and thorax, which result from union of the internal jugular and subclavian veins in the

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