Neural Excitation–Inhibition Imbalance in Cervical Spondylotic Myelopathy

Background Cervical spondylotic myelopathy (CSM) is a chronic spinal cord compression disorder associated with degenerative changes in the cervical spine. Although morphological alterations in brain regions associated with CSM have been reported, the underlying molecular regulatory mechanisms remain incompletely understood. This study aims to reveal the structural changes among different brain regions in CSM and their complex associations with specific transcriptional expression patterns.Methods The study includes 170 CSM patients and 79 healthy controls(age range: 40-65 years). MRI is used to acquire cortical data for each participant, and the morphometric similarity network is then constructed for each individual. A general linear model is applied to analyze cortical structural differences between patients and healthy controls. Subsequently, partial least squares regression is used to link these cortical structural differences with gene expression profiles from the AHBA, in order to identify associated genes for enrichment analysis.Results We find that, compared with healthy controls, CSM patients show generally increased MSN strength in the cerebral cortex. Additionally,the differentially expressed genes are specifically enriched in both excitatory and inhibitory neurons.Conclusions Our study reveals that structural network hubs are more susceptible to damage under chronic spinal cord compression, and that disruption of the dynamic balance between excitatory and inhibitory neurons may serve as a candidate mechanism driving secondary cortical remodeling.