Biomarkers and digital mobility¶
TL;DR — No blood, imaging or digital marker has completed the external validation and clinical-impact testing needed for routine diagnosis or treatment selection. A 2,340-participant smartphone-kinematics study reported external-cohort discrimination for DCM screening (AUC 0.856, 95% CI 0.818–0.895), but did not test whether its use improves patient outcomes (Jin 2026, PMID 42448819). Wearables and gait tests can quantify mobility more continuously, but DCM gait tools have inconsistent psychometric evidence (Choy 2022, PMID 35441108). Prospective DCM work is testing serum proteins (Vedantam 2025, PMID 40215624), microRNAs (Divi 2024, PMID 38711175) and plasma proteomics (Poulin 2026, PMID 41104894); these remain candidates. A useful biomarker must improve a decision beyond symptoms, examination, imaging and baseline function.
Biomarker use cases¶
Diagnosis, prognosis, treatment-effect prediction and monitoring are different claims requiring different designs. A marker associated with severity cannot automatically select decompression, and a postoperative change cannot prove neuroprotection.
Lumbar digital mobility¶
Accelerometry and inertial sensors can capture cadence, trunk posture, variability, walking bouts and daily steps. Early lumbar-stenosis digital gait studies are exploratory (Morimoto 2023, PMID 38162877). In DCM, a multicenter smartphone model was externally validated for screening discrimination, but treatment-selection and impact validation were not evaluated (Jin 2026, PMID 42448819); device placement, algorithms, adherence and meaningful-change thresholds remain unsettled.
DCM gait¶
A systematic review found 12 gait assessment tools across 20 studies, only five studies with very good methodological quality, and limited reliability evidence (Choy 2022, PMID 35441108). Delayed postural responses may expose balance-control deficits not represented in mJOA (Boerger 2022, PMID 35080466).
Imaging candidates¶
Cord signal, diffusion metrics, morphometry, brain changes and dynamic compression are studied as DCM biomarkers. Clinical and neuroradiological correlation remains incomplete (Soda 2022, PMID 36248151); cerebral gray/white matter associations may reflect adaptation or injury but are not clinical tests (Wang 2023, PMID 36828377).
Fluid biomarkers¶
Prospective serum-protein studies and circulating microRNA panels seek signatures of cord injury and recovery (Vedantam 2025, PMID 40215624) (Divi 2024, PMID 38711175). UK Biobank and registry proteomics expand scale (Poulin 2026, PMID 41104894) (Najib 2026, PMID 41902769), but external replication and incremental value are required.
A 69-person prospective DCM cohort combined clinical, structural MRI and MR-spectroscopy measures: adding three metabolite ratios increased internally validated discrimination for two-year recovery, but the model still requires prospective external validation before clinical implementation (Ramachandran 2026, PMID 42462976). A live PubMed search on 2026-08-30 therefore found externally validated screening discrimination for one digital tool and internally validated prognostic models, but no completed clinical-impact study or validated treatment-selection rule.
Prediction pitfalls¶
Small samples, many features, flexible preprocessing and weak external validation inflate accuracy. A model must be calibrated in the intended population, compared with a clinical baseline and evaluated on a decision consequence, not only discrimination.
Minimum validation pathway¶
Pre-specify the use case; lock acquisition and analysis; validate externally; report calibration and missingness; test incremental value; then run an impact study. Patient acceptability, device burden and unequal phone/wearable access are part of validity.
Decision table¶
| Candidate | Possible use | Current barrier |
|---|---|---|
| Daily steps | Real-world mobility | Wear time and opportunity |
| Gait variability | Early cord dysfunction | Device/algorithm heterogeneity |
| Postural responses | Fall vulnerability | Small cohorts |
| MRI cord signal | Injury burden/prognosis | Nonspecific and reader dependent |
| Diffusion imaging | Microstructure | Protocol harmonization |
| Serum proteins | Diagnosis/prognosis | External replication |
| MicroRNAs | Prediction | Multiplicity and platform effects |
| Proteomics | Pathway/subgroup discovery | Clinical incremental value |
Evidence map¶
The table records the page-specific live PubMed retrieval set; inclusion here maps evidence, not endorsement of every intervention.
| PMID | Year | Design | Contribution to this page |
|---|---|---|---|
| 35441108 | 2022 | systematic review | Gait assessment tools for degenerative cervical myelopathy: a systematic review (Choy 2022, PMID 35441108) |
| 40215624 | 2025 | prospective study | Serum protein biomarkers for degenerative cervical myelopathy: a prospective study (Vedantam 2025, PMID 40215624) |
| 38711175 | 2024 | clinical/observational study | Circulating microRNAs May Be Predictive of Degenerative Cervical Myelopathy (Divi 2024, PMID 38711175) |
| 41104894 | 2026 | clinical/observational study | Plasma Proteomic Biomarkers of Degenerative Cervical Myelopathy in the UK Biobank (Poulin 2026, PMID 41104894) |
| 38162877 | 2023 | review | Gait analysis using digital biomarkers including smart shoes in lumbar spinal canal stenosis: a scopin… (Morimoto 2023, PMID 38162877) |
| 35080466 | 2022 | clinical/observational study | Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predi… (Boerger 2022, PMID 35080466) |
| 36248151 | 2022 | clinical/observational study | Degenerative cervical myelopathy: Neuroradiological, neurophysiological and clinical correlations in 2… (Soda 2022, PMID 36248151) |
| 36828377 | 2023 | clinical/observational study | Structural Relationship between Cerebral Gray and White Matter Alterations in Degenerative Cervical My… (Wang 2023, PMID 36828377) |
| 41902769 | 2026 | clinical/observational study | Plasma proteomics implicates NOX-driven redox imbalance in degenerative cervical myelopathy: findings … (Najib 2026, PMID 41902769) |
| 42448819 | 2026 | clinical/observational study | Smartphone-based kinematic biomarkers for degenerative cervical myelopathy screening robust to physiological aging (Jin 2026, PMID 42448819) |
| 42462976 | 2026 | prospective study | Preoperative metabolite ratio improves prediction of postoperative recovery in degenerative cervical myelopathy (Ramachandran 2026, PMID 42462976) |
| 33496544 | 2021 | prospective study | Predictors of Falls in Patients with Degenerative Cervical Myelopathy: A Prospective Multi-institution… (Inose 2021, PMID 33496544) |
| 41375651 | 2025 | review | Advancing Precision Medicine in Degenerative Cervical Myelopathy (Al-Shawwa 2025, PMID 41375651) |
| 40459154 | 2025 | clinical/observational study | Degenerative cervical myelopathy: timing of surgery (Fasinella 2025, PMID 40459154) |
| 34689848 | 2022 | review | Degenerative Cervical Myelopathy: Towards a Personalized Approach (Hejrati 2022, PMID 34689848) |
| 41097809 | 2026 | meta-analysis | Assessment of Cerebrospinal Fluid and Blood-Based Biomarkers in Degenerative Cervical Myelopathy: Syst… (Arora 2026, PMID 41097809) |
| 34336494 | 2021 | review | Bench to Bedside: Proteomic Biomarker Analysis of Cerebrospinal Fluid in Patients With Spondylomyelopa… (Fiani 2021, PMID 34336494) |
| 35444605 | 2022 | clinical/observational study | Dynamic and Static Amplitude of Low-Frequency Fluctuation Is a Potential Biomarker for Predicting Prog… (Fan 2022, PMID 35444605) |
| 38992236 | 2024 | clinical/observational study | Sex-specific alterations in functional connectivity and network topology in patients with degenerative… (Oughourlian 2024, PMID 38992236) |
| 38974484 | 2024 | systematic review | Updates in current concepts in degenerative cervical myelopathy: a systematic review (Thompson 2024, PMID 38974484) |
| 31476852 | 2019 | review | Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management (Wilson 2019, PMID 31476852) |
| 36208893 | 2022 | review | Degenerative Cervical Myelopathy: Evaluation and Management (Williams 2022, PMID 36208893) |
| 33320508 | 2020 | clinical/observational study | Degenerative Cervical Myelopathy: Recognition and Management (Kane 2020, PMID 33320508) |
| 38213348 | 2023 | review | Degenerative Cervical Myelopathy: An Overview (Saunders 2023, PMID 38213348) |
| 29599656 | 2018 | review | Degenerative Cervical Myelopathy: A Clinical Review (Gibson 2018, PMID 29599656) |
| 35043715 | 2022 | clinical/observational study | Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis (Tetreault 2022, PMID 35043715) |
| 38285428 | 2024 | review | Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach (Gallagher 2024, PMID 38285428) |
| 36447347 | 2022 | review | New Imaging Modalities for Degenerative Cervical Myelopathy (Rajan 2022, PMID 36447347) |
| 39364309 | 2024 | clinical/observational study | Patterns of cortical thickness alterations in degenerative cervical myelopathy: associations with dext… (Muhammad 2024, PMID 39364309) |
| 40434581 | 2025 | clinical/observational study | Prevalence of idiopathic normal pressure hydrocephalus in patients with degenerative cervical myelopathy (Yu 2025, PMID 40434581) |
| 40591976 | 2025 | review | Diagnosis and Management of Degenerative Cervical Myelopathy (Mechas 2025, PMID 40591976) |
| 33781560 | 2021 | review | Degenerative cervical myelopathy (Marie-Hardy 2021, PMID 33781560) |
Interpretation rules¶
- Anatomical narrowing is necessary but not sufficient for a symptomatic stenosis diagnosis.
- Lumbar claudication, lumbar radiculopathy, cervical myelopathy and imaging-only compression are analyzed separately.
- Absolute changes, confidence intervals and responder proportions outrank within-group significance.
- Comparator choice determines the question a trial can answer.
- Reoperation, falls, delirium and recovery burden are outcomes, not footnotes.
- Subgroup claims require an interaction or externally validated treatment-effect model.
- Older age is not a contraindication; reserve, goals and modifiable vulnerability are assessed directly.
- Absence of deterioration in a cohort does not guarantee individual stability.
- Evidence is research knowledge, not individualized medical advice.
Open questions¶
- Which gait tool is responsive to clinically meaningful DCM change and reproducible across centers and devices? (Choy 2022, PMID 35441108)
- Do serum NfL, IL-6 or BDNF add externally validated diagnostic or prognostic value beyond clinical severity and imaging? (Vedantam 2025, PMID 40215624)
- Can the reported circulating-microRNA profile be replicated prospectively on a locked assay platform and linked to a decision consequence? (Divi 2024, PMID 38711175)
Related pages¶
- Anatomy, classification and imaging — connected evidence domain.
- Epidemiology and natural history — connected evidence domain.
- Lumbar stenosis and neurogenic claudication — connected evidence domain.
- Cervical stenosis and degenerative myelopathy — connected evidence domain.
- Diagnosis and differential diagnosis — connected evidence domain.
- Overview — map of the whole condition.
References¶
- Choy WJ, et al. Gait assessment tools for degenerative cervical myelopathy: a systematic review. Journal of spine surgery (Hong Kong). 2022;8:149-162. PMID 35441108
- Vedantam A, et al. Serum protein biomarkers for degenerative cervical myelopathy: a prospective study. Journal of neurosurgery. Spine. 2025;42:718-726. PMID 40215624
- Divi SN, et al. Circulating microRNAs May Be Predictive of Degenerative Cervical Myelopathy. Spine. 2024;49:1393-1400. PMID 38711175
- Poulin ND, et al. Plasma Proteomic Biomarkers of Degenerative Cervical Myelopathy in the UK Biobank. Neurosurgery. 2026;99:209-217. PMID 41104894
- Morimoto T, et al. Gait analysis using digital biomarkers including smart shoes in lumbar spinal canal stenosis: a scoping review. Frontiers in medicine. 2023;10:1302136. PMID 38162877
- Boerger TF, et al. Degenerative cervical myelopathy delays responses to lateral balance perturbations regardless of predictability. Journal of neurophysiology. 2022;127:673-688. PMID 35080466
- Soda C, et al. Degenerative cervical myelopathy: Neuroradiological, neurophysiological and clinical correlations in 27 consecutive cases. Brain & spine. 2022;2:100909. PMID 36248151
- Wang C, et al. Structural Relationship between Cerebral Gray and White Matter Alterations in Degenerative Cervical Myelopathy. Tomography (Ann Arbor, Mich.). 2023;9:315-327. PMID 36828377
- Najib N, et al. Plasma proteomics implicates NOX-driven redox imbalance in degenerative cervical myelopathy: findings from the Australian MYelopathy Natural History Registry [AO Spine RECODE-DCM research priority number 5]. Redox report : communications in free radical research. 2026;31:2649669. PMID 41902769
- Inose H, et al. Predictors of Falls in Patients with Degenerative Cervical Myelopathy: A Prospective Multi-institutional Study. Spine. 2021;46:1007-1013. PMID 33496544
- Al-Shawwa A, et al. Advancing Precision Medicine in Degenerative Cervical Myelopathy. Journal of clinical medicine. 2025;14. PMID 41375651
- Fasinella MR, et al. Degenerative cervical myelopathy: timing of surgery. EFORT open reviews. 2025;10:403-415. PMID 40459154
- Hejrati N, et al. Degenerative Cervical Myelopathy: Towards a Personalized Approach. The Canadian journal of neurological sciences. Le journal canadien des sciences neurologiques. 2022;49:729-740. PMID 34689848
- Arora H, et al. Assessment of Cerebrospinal Fluid and Blood-Based Biomarkers in Degenerative Cervical Myelopathy: Systematic Review and Meta-Analysis. Global spine journal. 2026;16:1619-1632. PMID 41097809
- Fiani B, et al. Bench to Bedside: Proteomic Biomarker Analysis of Cerebrospinal Fluid in Patients With Spondylomyelopathy. Cureus. 2021;13:e16003. PMID 34336494
- Fan N, et al. Dynamic and Static Amplitude of Low-Frequency Fluctuation Is a Potential Biomarker for Predicting Prognosis of Degenerative Cervical Myelopathy Patients: A Preliminary Resting-State fMRI Study. Frontiers in neurology. 2022;13:829714. PMID 35444605
- Oughourlian TC, et al. Sex-specific alterations in functional connectivity and network topology in patients with degenerative cervical myelopathy. Scientific reports. 2024;14:16020. PMID 38992236
- Thompson K, et al. Updates in current concepts in degenerative cervical myelopathy: a systematic review. Journal of spine surgery (Hong Kong). 2024;10:313-326. PMID 38974484
- Wilson JRF, et al. Degenerative Cervical Myelopathy; A Review of the Latest Advances and Future Directions in Management. Neurospine. 2019;16:494-505. PMID 31476852
- Williams J, et al. Degenerative Cervical Myelopathy: Evaluation and Management. The Orthopedic clinics of North America. 2022;53:509-521. PMID 36208893
- Kane SF, et al. Degenerative Cervical Myelopathy: Recognition and Management. American family physician. 2020;102:740-750. PMID 33320508
- Saunders LM, et al. Degenerative Cervical Myelopathy: An Overview. Cureus. 2023;15:e50387. PMID 38213348
- Gibson J, et al. Degenerative Cervical Myelopathy: A Clinical Review. The Yale journal of biology and medicine. 2018;91:43-48. PMID 29599656
- Tetreault L, et al. Degenerative Cervical Myelopathy: A Practical Approach to Diagnosis. Global spine journal. 2022;12:1881-1893. PMID 35043715
- Gallagher DO, et al. Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach. Clinical spine surgery. 2024;37:1-8. PMID 38285428
- Rajan PV, et al. New Imaging Modalities for Degenerative Cervical Myelopathy. Clinical spine surgery. 2022;35:422-430. PMID 36447347
- Muhammad F, et al. Patterns of cortical thickness alterations in degenerative cervical myelopathy: associations with dexterity and gait dysfunctions. Brain communications. 2024;6:fcae279. PMID 39364309
- Yu J, et al. Prevalence of idiopathic normal pressure hydrocephalus in patients with degenerative cervical myelopathy. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. 2025;34:3243-3252. PMID 40434581
- Mechas CA, et al. Diagnosis and Management of Degenerative Cervical Myelopathy. The Journal of the American Academy of Orthopaedic Surgeons. 2025;33:e1462-e1476. PMID 40591976
- Marie-Hardy L, et al. Degenerative cervical myelopathy. Revue neurologique. 2021;177:490-497. PMID 33781560
- Jin Y, et al. Smartphone-based kinematic biomarkers for degenerative cervical myelopathy screening robust to physiological aging. NPJ digital medicine. 2026. PMID 42448819
- Ramachandran K, et al. Preoperative metabolite ratio improves prediction of postoperative recovery in degenerative cervical myelopathy: a prospective cohort study. The spine journal. 2026. PMID 42462976