Genetic and Molecular Biomarkers for Predicting Outcomes in Traumatic and Nontraumatic Spinal Cord Injury

Spinal cord injury and degenerative cervical myelopathy cause significant neurologic morbidity with highly variable outcomes that are difficult to predict using conventional clinical and imaging assessments. This review synthesizes evidence from 52 studies on genetic and molecular biomarkers, including neuroaxonal proteins, inflammatory mediators, metabolic markers, and genetic variants. Neurofilament light chain, glial fibrillary acidic protein, and apolipoprotein E ε4 emerged as shared prognostic markers, while etiology-specific signatures reflect distinct pathophysiology. Multimodal panels consistently outperformed single-marker approaches, and biomarker utility proved highly context-dependent in terms of assay timing and sampling compartment. Future large-scale validation is essential before clinical implementation.