Exploring the Landscape of Biomarkers in Spinal Cord Injury.
Paulina S Scheuren, Bethany R Kondiles, Angela R Filous and 14 others
PMID 40585008WHAT IT FOUND
Spinal cord injury lacks FDA-approved biomarkers for predicting recovery, so clinicians must still rely on the ISNCSCI exam despite its variability.
This review maps emerging candidates like serum proteins and MRI tissue bridges, but none are ready for routine clinical use yet.
Key findings
01There is currently no US Food and Drug Administration (FDA)–qualified biomarker for injury status, severity, or prognosis in spinal cord injury (SCI), unlike in traumatic brain injury.
02The International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) remains the gold standard but is not a prediction tool and struggles to predict recovery due to spontaneous recovery variability.
03Emerging biomarkers such as serum neurofilament light chain (NFL) and glial fibrillary acidic protein (GFAP) show promise for predicting outcomes, particularly when measured 48 to 72 hours post-injury, but have not replaced clinical assessment.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is a narrative review, not a systematic review or meta-analysis, so the selection of studies may be subject to author bias. The field lacks FDA-qualified biomarkers, meaning all discussed candidates are in the research or validation phase and not ready for clinical use. Many biomarkers require specialized, costly equipment or invasive sampling (e.g., CSF), limiting their current practical application in standard clinical settings. The review notes that biomarkers must prove superior to existing clinical prediction rules (like the ISNCSCI) to be adopted, a bar that most candidates have not yet cleared.
Declared interests
The authors declare no conflicts of interest.
The easy way to misread this
Do not interpret the discussion of promising biomarkers like serum NFL, GFAP, or MRI tissue bridges as evidence that these tests are available or recommended for clinical use. They are not yet validated for routine practice, and the ISNCSCI exam remains the standard of care for predicting recovery.