Combined plasma and imaging biomarkers as predictors of neurological outcome in cervical traumatic spinal cord injury

The cervical traumatic spinal cord injury (TSCI) frequently results in profound neurological impairment, but reliable early prediction of outcomes remains difficult. Although the AIS grade is the standard clinical tool, its prognostic accuracy is constrained. Imaging-derived parameters from MRI and blood-based biomarkers have been proposed as valuable adjuncts, yet their integrated predictive significance has not been clearly defined. We enrolled a total of 71 patients with acute cervical TSCI, who were admitted to the First Affiliated Hospital of Nanchang University. The MRI parameters assessed included intramedullary lesion length (IMLL), maximum spinal cord compression (MSCC), and maximum canal compromise (MCC). Serum biomarkers, including Tau, GFAP, and CNTN1, as well as blood cell counts (WBC, neutrophils, lymphocytes, and monocytes), were also measured. Analyses were performed to evaluate the associations between MRI parameters, serum biomarkers, blood cell counts, and prognosis. Improvement in at least one American Spinal Injury Association Impairment Scale (AIS) grade was defined as AIS grade conversion. Admission AIS grade was strongly correlated with patient outcomes (p < 0.05), with higher admission AIS grades associated with a worse prognosis. Among the MRI measures, a shorter IMLL was independently associated with AIS grade improvement (p < 0.01). Tau concentration also served as an independent predictor of neurological recovery (p < 0.001), while CNTN1 and GFAP did not retain statistical significance (p > 0.05). ROC analysis indicated that Tau and IMLL provided moderate discriminative ability individually, with AUC values of 0.750 and 0.650, respectively. Notably, combining these factors with admission AIS grade substantially enhanced predictive accuracy, yielding an AUC of 0.936 (p < 0.001), which was superior to any individual predictor. This study indicate that both IMLL and Tau serve as independent predictors of neurological outcome in cervical TSCI. Integrating MRI parameters, serum biomarkers, and AIS grade into a single model markedly enhances prognostic accuracy, highlighting its potential value for clinical decision-making and individualized treatment planning.