Identification of Cerebrospinal Fluid Proteomic Signatures Associated with Intramedullary Surgery Outcome

Abstracts ImportanceNeurological function recovery after intramedullary microsurgery is susceptible to various factors. Investigating alterations in cerebrospinal fluid (CSF) protein profiles associated with spinal function recovery could provide valuable insights into prognosis and the development of postoperative therapeutic approaches. ObjectiveThe aim of this research was to identify CSF protein sets linked to recovery outcomes of intramedullary microsurgery. DesignThis research is an observational cohort investigation that collected data from August 2020 to March 2023. SettingThe Neurospine group conducted this single-centered cohort research (http://www.chictr.org.cn, registration ID: ChiCTR2300072704). Participants were followed up for 6 months or more. CSF samples were collected pre-and postoperatively. Perioperative treatments, neurological deficits, and rehabilitation therapies were recorded. ParticipantsThe Neurospine group screened adult patients with intramedullary lesions scheduled for surgical intervention. The exclusion criteria included prior spinal surgery, neurological disorders, surgical complications, or relevant medications. ExposuresThe patients underwent standard intramedullary microsurgical procedures, received medications, and underwent assessments. The CSF protein profiles were examined using tandem mass spectrometry. Main outcomes and measuresThe evaluation of spinal function recovery involved various assessments and correlation analysis was performed. In addition, CSF protein features were identified and their clinical associations were assessed using least absolute shrinkage and selection operator (LASSO) regression modeling. ResultsOf the 43 patients who completed follow-up assessments, 23 were women and 20 were men, with a mean age of 42.8{+/-}11.8 years. Histological diagnoses confirmed invasive lesions in 20 patients. Twenty-three patients demonstrated stable or improved spinal function, while 20 patients experienced deterioration during the 3rd and 6th month follow-ups. As indicated by the changes in EMS scales (P = 0.02) and JOA scores (P = 0.03), functional prognosis was associated with pathological characteristics. We developed four models using the CSF proteomics datasets of noninvasive and invasive patients. These LASSO regression models exhibited high accuracy in predicting the recovery rates of the corresponding groups (P > 0.99). Conclusions and relevanceThis research demonstrates that lesion sizes and pathological characteristics are significant factors influencing spinal function recovery. The LASSO regression models developed using identified CSF protein variables for invasive and noninvasive patients, respectively, offer novel methods for the prediction of prognosis and the development of therapeutic approaches.