Christian Blume1, Matthias Florian Geiger2, Lars Ove Brandenburg3, Marguerite Müller4, Verena Mainz5, Johannes Kalder6, Walid Albanna2, Hans Clusmann2, Christian Andreas Mueller2. 1. Department of Neurosurgery, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. cblume@ukaachen.de. 2. Department of Neurosurgery, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. 3. Institute of Anatomy and Cell Biology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. 4. Department of Neuroradiology, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany. 5. Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstrasse 19, 52074, Aachen, Germany. 6. Department of Vascular Surgery, RWTH Aachen University, Pauwelsstrasse 30, 52074, Aachen, Germany.
Abstract
PURPOSE: The aim of this study is to detect the presence of blood spinal cord barrier (BSCB) disruption in patients with degenerative cervical myelopathy (DCM). METHODS: In this prospective non-randomized controlled cohort study, 28 patients with DCM were prospectively included. All patients had indication for neurosurgical decompression. Furthermore, 38 controls with thoracic abdominal aortic aneurysm (TAAA) and indication for surgery were included. All patients underwent neurological examination. Regarding BSCB disruption and intrathecal immunoglobulin (Ig) concentrations, cerebrospinal fluid (CSF) and blood serum were examined for albumin, IgG, IgA and IgM. Quotients (Q) (CSF/serum) were standardized and calculated according to Reibers' diagnostic criteria. RESULTS: Patients and controls distinguished significantly in their clinical status. AlbuminQ, as expression of BSCB disruption, was significantly increased in the DCM patients compared to the controls. Quotients of IgG and IgA differed significantly between the groups as an expression of intrathecal diffusion. In the subgroup analysis of patients with mild/moderate clinical status of myelopathy and patients with severe clinical status, the disruption of the BSCB was significantly increased with clinical severity. Likewise, IgAQ and IgGQ presented increased quotients related to the clinical severity of myelopathy. CONCLUSION: In this study, we detected an increased permeability and disruption of the BSCB in DCM patients. The severity of BSCB disruption and the diffusion of Ig are related to the clinical status in our patient cohort. Having documented this particular pathomechanism in patients with DCM, we suggest that this diagnostic tool cloud be an important addition to surgical decision making in the future. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: The aim of this study is to detect the presence of blood spinal cord barrier (BSCB) disruption in patients with degenerative cervical myelopathy (DCM). METHODS: In this prospective non-randomized controlled cohort study, 28 patients with DCM were prospectively included. All patients had indication for neurosurgical decompression. Furthermore, 38 controls with thoracic abdominal aortic aneurysm (TAAA) and indication for surgery were included. All patients underwent neurological examination. Regarding BSCB disruption and intrathecal immunoglobulin (Ig) concentrations, cerebrospinal fluid (CSF) and blood serum were examined for albumin, IgG, IgA and IgM. Quotients (Q) (CSF/serum) were standardized and calculated according to Reibers' diagnostic criteria. RESULTS:Patients and controls distinguished significantly in their clinical status. AlbuminQ, as expression of BSCB disruption, was significantly increased in the DCMpatients compared to the controls. Quotients of IgG and IgA differed significantly between the groups as an expression of intrathecal diffusion. In the subgroup analysis of patients with mild/moderate clinical status of myelopathy and patients with severe clinical status, the disruption of the BSCB was significantly increased with clinical severity. Likewise, IgAQ and IgGQ presented increased quotients related to the clinical severity of myelopathy. CONCLUSION: In this study, we detected an increased permeability and disruption of the BSCB in DCMpatients. The severity of BSCB disruption and the diffusion of Ig are related to the clinical status in our patient cohort. Having documented this particular pathomechanism in patients with DCM, we suggest that this diagnostic tool cloud be an important addition to surgical decision making in the future. These slides can be retrieved under Electronic Supplementary Material.
Authors: Najmeh Kheram; Nikolai Pfender; Andrea Boraschi; Mazda Farshad; Vartan Kurtcuoglu; Armin Curt; Martin Schubert; Carl M Zipser Journal: Front Neurol Date: 2022-08-09 Impact factor: 4.086