Fig. 2

Blood spinal cord barrier disruption during and after cervical decompression in degenerative cervical myelopathy. Spinal cord perfusion is maintained by the anterior spinal artery, left/right posterior spinal arteries, and their associated veins. Chronic cervical cord compression (schematically represented as anterior compression alone) causes pathological changes to these supplying vessels and disrupts the BSCB. Spinal cord tissues remain hypoperfused despite vascular remodeling. Following surgical decompression, there is sudden restoration in blood flow but the BSCB remains hyperpermeable. This predisposes the cord to reperfusion injury and impairs neurological recovery, although the underlying mechanical compression has been relieved. Bright red and blue colors denote healthy blood vessels, while dark red and blue colors indicate blood vessels with compromised blood supply. Pink-shaded regions indicate mildly hypoxic regions, while darker pink-shaded regions indicate ischemic regions with severe ischemia