Resident UPMC Department of Neurosurgery Pittsburgh, PA, US
Disclosure(s):
Gautam Nayar, MD: No financial relationships to disclose
Introduction: There is a scarcity of literature exploring fluid-based biomarkers that have the potential to provide deeper insights into the cellular mechanisms underlying CSM symptom presentation and postoperative recovery. This systematic review aims to synthesize the literature on invasive, fluid-based biomarkers and their clinical significance with CSM.
Methods: A comprehensive search strategy was developed for concepts of biomarkers and CSM and executed in Embase.com, Ovid-Medline All, Cochrane Library, Scopus, and Web of Science from database inception. Retrieved results underwent title, abstract, and full-text screening with inclusion criteria being original research including animal or human subjects affected by CSM/compression myelopathy that investigated the relationship between a fluid-based biomarker and CSM. Risk-of-bias was reported using the OHAT Risk of Bias Rating Tool.
Results: The search strategy resulted in 191 unique manuscripts, with 20 meeting the predetermined inclusion/exclusion criteria and included in final analysis. Of these, 15 (75.0%) were human studies, two (10.0%) were animal studies, and three (15.0%) included both human and animal studies. Across human studies, the fluid utilized for biomarker assessment was blood, (N=8, 44.4%), cerebrospinal fluid (CSF) (N=9, 50.0%), and both blood and CSF (N=1, 5.6%). The three most common biomarkers assessed across human studies were NSE (N=4, 22.2%), S100b (N=4, 22.2%), and pNF-H (N=4, 22.2%). A diverse array of correlations was documented between numerous blood- and CSF-based biomarkers and CSM, identifying several that were associated with symptom severity and long-term outcomes. Risk of bias due to inadequate comparison groups was present in three human studies (16.7%) and two animal studies (40%).
Conclusion : This comprehensive systematic review identified several associations between CSM and fluid-based neural, glial, and inflammatory biomarkers. The three most commonly assessed biomarkers were NSE, S100b, and pNF-H. The vast heterogeneity across studies necessitates future research within larger, prospective patient cohorts to fully elucidate the utility these biomarkers may hold in the clinical evaluation of patients with CSM.