Exploring Neuroinflammation and Its Role in Postoperative Cognitive Dysfunction following Spine Surgery.

Area of Science:

• Neuroscience
• Geriatric Medicine
• Surgical Research

Background:

• Postoperative cognitive dysfunction (POCD) is a concern in older patients undergoing spine surgery, linked to adverse outcomes.
• Neuroinflammation's role in accelerating neurodegeneration and contributing to POCD requires further investigation.
• Identifying biomarkers for POCD risk is crucial for managing older patients with disabling spine disease.

Purpose of the Study:

• To investigate if pro-neuroinflammatory states accelerate neurodegeneration, leading to POCD in elderly spine surgery patients.
• To explore the predictive value of specific biomarkers for POCD risk in this population.

Main Methods:

• Elderly patients (≥ 60 years) undergoing elective spine surgery were enrolled.
• Preoperative and postoperative levels of key biomarkers (IL-6, CRP, S100β, BDNF, sNFL, gasdermin D, sTREM2) were measured.
• Cognitive function was assessed using the CERAD test battery at baseline and 3 months postoperatively.

Main Results:

• Elevated postoperative sTREM2 and gasdermin D levels correlated significantly with cognitive performance decline, especially in memory.
• Higher sTREM2 was linked to greater memory decline, while higher gasdermin D impacted recognition memory.
• Increased preoperative serum neurofilament light chain protein (sNFL) levels predicted poorer cognitive outcomes across multiple domains.

Conclusions:

• Neuroinflammation is potentially associated with cognitive decline following spine surgery in older adults.
• Targeting neuroinflammatory pathways may be key to mitigating POCD.
• Biomarkers identified could help stratify risk and guide personalized interventions for POCD.