Blood-spinal cord barrier disruption in degenerative cervical myelopathy

Abstract

Degenerative cervical myelopathy (DCM) is the most prevalent cause of spinal cord dysfunction in the aging population. Significant neurological deficits may result from a delayed diagnosis as well as inadequate neurological recovery following surgical decompression. Here, we review the pathophysiology of DCM with an emphasis on how blood-spinal cord barrier (BSCB) disruption is a critical yet neglected pathological feature affecting prognosis. In patients suffering from DCM, compromise of the BSCB is evidenced by elevated cerebrospinal fluid (CSF) to serum protein ratios and abnormal contrast-enhancement upon magnetic resonance imaging (MRI). In animal model correlates, there is histological evidence of increased extravasation of tissue dyes and serum contents, and pathological changes to the neurovascular unit. BSCB dysfunction is the likely culprit for ischemia–reperfusion injury following surgical decompression, which can result in devastating neurological sequelae. As there are currently no therapeutic approaches specifically targeting BSCB reconstitution, we conclude the review by discussing potential interventions harnessed for this purpose.

Biomaterials targeting the microenvironment for spinal cord injury repair: progression and perspectives

“…Alginate also enhances TLR-NF-kb-mediated phagocytosis of macrophages. Alginate activates the AKT/NF-kb and p38MAPK pathways by increasing TLR4 expression, which induces macrophage activation and enhances phagocytosis in mouse macrophages ( Kim et al, 2023 ). While natural hydrogels have significant biocompatibility, their mechanical qualities are rather poor.…”

Spinal Cord Injury Management Based on Microglia-Targeting Therapies

“…To ensure high selectivity, the endothelial cells have a small number of endocytic processes and are closely sealed by tight junctions (TJs) [17], special intercellular protein bridges that will be discussed in detail below. Another particularity of the BSCB's endothelium is the higher concentration of mitochondria compared to the BBB's endothelium, which might be explained by the increased metabolic need in the spinal cord [18].…”