Preoperative blood spinal cord barrier biomarker levels correlate with neurological outcome in patients with degenerative cervical myelopathy one year after surgery: a prospective cohort study.

Abstract

Degenerative cervical myelopathy (DCM) is the leading cause of chronic spinal cord dysfunction and can lead to severe neurological impairment if untreated. While decompressive surgery is the standard treatment, predicting postoperative recovery remains a challenge. This study evaluates whether preoperative cerebrospinal fluid (CSF)/serum albumin and immunoglobulin (IgG and IgA) ratios, as indicators of blood-spinal cord barrier (BSCB) disruption, are associated biomarkers with long-term neurological recovery following surgery. We conducted a prospective, single-center cohort study involving 49 DCM patients (29 males, 20 females, mean age 61 ± 17), with 38 completing a one-year follow-up. Preoperative BSCB integrity was assessed using Reiber diagnostics, which evaluates CSF/serum protein ratios. Neurological status was assessed using the modified Japanese Orthopedic Association (mJOA) score. Our results show a significant correlation between preoperative albumin, IgG and IgA CSF/serum ratios and the one-year postoperative mJOA score (all p = .048). Lower ratios, predominantly accompanying a less severe BSCB disruption, were associated with better neurological outcome (mJOA). These findings suggest that preoperative CSF/serum ratios have the potential to serve as biomarkers for postoperative recovery in DCM, supporting more personalized treatment planning. However, larger studies with more extensive cohorts are needed to validate these results and improve the statistical power of subgroup analyses. Future research should focus on refining BSCB-related diagnostics to enhance preoperative risk assessment.