Assessment of Cerebrospinal Fluid and Blood-Based Biomarkers in Degenerative Cervical Myelopathy: Systematic Review and Meta-Analysis

Study Design: Systematic Review and Meta-Analysis. Objectives: Degenerative cervical myelopathy (DCM), the leading cause of spinal cord injury globally, may clinically manifest with hand numbness and tingling, loss of hand dexterity and impaired balance and gait. Biomarkers have been identified as disease indicators with recent studies exploring the role of structural and inflammatory biomarkers in diagnostic and treatment outcome prediction. The review aims to identify relevant cerebrospinal fluid (CSF) and blood-based biomarkers associated with DCM diagnosis and prognostication. Methods: The systematic review was conducted as per PRISMA guidelines. A comprehensive search strategy was devised to identify articles evaluating biomarkers in DCM and comparative control cohorts. The studies were screened by two independent reviewers and discrepancies resolved by a third author. Study characteristics were recorded, and data synthesis was performed to allow for pooled analyses. The quality of included studies and risk of bias were assessed using the QUADAS-2 tool. Results: A total of 17 studies incorporating 699 individuals with DCM and 475 controls were included. 9 studies evaluated CSF biomarkers while 6 and 2 studies reviewed blood-based and CSF-to-serum quotients, respectively. Pooled analyses revealed significantly higher levels of NF-L and IL-6, albumin-Q, IgA-Q, and IgG-Q in the DCM cohort as compared to the control group. Conclusion: This systematic review highlights the structural and inflammatory biomarkers that can be potentially used as substitutes for diagnosing and prognosticating outcomes for DCM. The findings further suggest the need for larger prospective studies to assess the clinical relevance of these biomarkers in DCM management.