Abstract
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.
Plain Language Summary
Using brain morphometric network analysis, this study finds enhanced interregional connectivity in patients with cervical spondylotic myelopathy. By integrating human brain gene expression data, it further reveals that these structural changes are associated with specific gene expression, with these genes enriched in particular neuron types, suggesting an imbalance between excitatory and inhibitory neurons. This research provides new insights into the molecular mechanisms underlying brain alterations in CSM.
Acknowledgements
We express our gratitude to all participants for contributing brain data essential to this study.
Funding
This study was funded by the following funding sources: the First Affiliated Hospital of Anhui Medical University Clinical Research Project (Grant No. LCYJ2021YB018), University Natural Science Research Major Project of Anhui Province (2025AHGXZK20147), University Natural Science Research Key Project of Anhui Province (Grant No. 2022AH051158), Horizontal Research Project of Anhui Medical University (9021755201), and Health Research Project of Anhui Province (Grant No. AHWJ2023A20125).
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Wu, H., Zhu, K., Wang, H. et al. Neural Excitation–Inhibition Imbalance in Cervical Spondylotic Myelopathy. Commun Med (2026). https://doi.org/10.1038/s43856-026-01661-z
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DOI: https://doi.org/10.1038/s43856-026-01661-z
