Fig. 3

Components of the blood spinal cord barrier (BSCB) and therapeutic strategies for BSCB reconstitution in degenerative cervical myelopathy (DCM). Left panel—At the BSCB, the presence of non-fenestrated endothelial cells establishes tight junctions that heavily restrict paracellular transport. At the capillary level, the basement membrane is closely associated with astrocyte end-feet, resulting in the elimination of the perivascular space. Pericytes, embedded within the basement membrane, assume a crucial role in facilitating endothelial cell maturation, supporting the basement membrane, and potentially modulating blood flow. Disruption of the BSCB integrity is characterized by the thickening or swelling of the basement membrane, endothelial cells, pericytes, and astrocytes. Deterioration of the tight junctions leads to the leakage of serum contents into the surrounding tissues. Inflammation leads to the transient formation of the perivascular space at the capillary level, thereby enabling leukocytes infiltration into the spinal cord parenchyma. Right panel—The treatment modalities mentioned in this figure are elaborated in the main text