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

<p>Introduction: Progress in spine surgery has significantly improved the safety of procedures for older patients with disabling spine disease. However, postoperative cognitive dysfunction (POCD) remains a concern due to their link with poorer outcomes and higher long-term care risk. This study aimed to determine if pro-neuroinflammatory states accelerate neurodegeneration, contributing to POCD development, and explore whether specific biomarkers could predict POCD risk. METHODS: Patients (aged ≥ 60 years) scheduled for elective spine surgery between February 2018 and March 2020 were enrolled. Biomarkers tested included IL-6, C-reactive protein, S100 calcium-binding protein β, brain-derived neurotrophic factor, serum neurofilament light chain protein (sNFL), gasdermin D, and soluble ectodomain of triggering receptor expressed on myeloid cells 2 (sTREM2), measured preoperatively and postoperatively. Cognitive outcomes were assessed using the CERAD test battery at baseline and 3 months postoperatively. RESULTS: Postoperative levels of sTREM2 and gasdermin D were significantly associated with cognitive performance changes 3 months after surgery, particularly in memory function. Higher sTREM2 levels were associated with greater cognitive decline, with six out of twelve CERAD items showing an inverse association (e.g., overall β = -0.010, p = 0.0003). Similarly, higher postoperative gasdermin D levels were linked to worse performance, particularly in recognition memory (e.g., word list recognition β = -0.615, p = 0.032). Additionally, higher preoperative sNFL levels were associated with poorer cognitive outcomes across multiple domains. CONCLUSIONS: This study highlights potential associations between neuroinflammation and cognitive decline following spine surgery. Targeting neuroinflammatory pathways could be crucial in mitigating POCD in older patients. Biomarkers may help identify high-risk patients and guide the development of targeted interventions. </p>.