BACKGROUND CONTEXT: Degenerative cervical spondylotic myelopathy (DCM) is the com-monest form of spinal cord injury in adults. However, a limited number of clinical reports have assessed the role of biomarkers in DCM.PURPOSE: We evaluated cerebrospinal fluid (CSF) biomarkers in patients scheduled for DCM surgery and hypothesized that CSF biomarkers levels (1) would reflect the severity of preoperative neurological status; and (2) correlate with radiological appearance; and (3) correlate with clinical outcome.STUDY DESIGN/SETTING: Prospective clinical and laboratory study. PATIENT SAMPLE: Twenty-three DCM patients, aged 66.4 & PLUSMN;12.8 years and seven controls aged 45.4 +/- 5.3 years were included.OUTCOME MEASURES: The American Spinal Injury Association Impairment Scale, the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire and EuroQol 5 -dimensions were assessed preoperatively and at 3 months post-surgery.METHODS: We measured preoperative biomarkers (glial fibrillary acidic protein [GFAP], neuro-filament light [NFL], phosphorylated neurofilament-H [pNF-H] and Ubiquitin C-terminal hydro -lase L1) in CSF samples collected from patients with progressive clinical DCM who underwent surgical treatment. Biomarker concentrations in DCM patients were compared with those of cervical radiculopathy controls.RESULTS: The median symptom duration was 10 (interquartile range 6) months. The levels of GFAP, NFL, pNF-H, Ubiquitin C-terminal hydrolase L1 were significantly higher in the DCM group compared to controls (p=.044, p=.002, p=.016, and p=.006, respectively). Higher pNF-H levels were found in patients with low signal on T1 Magnetic Resonance Imaging sequence compared to those without (p=.022, area under the receiver operating characteristic curve [AUC] 0.780, 95% Confidence Interval: 0.59-0.98). Clinical improvement following surgery correlated mainly with NFL and GFAP levels (p <.05). CONCLUSIONS: Our results suggest that CSF biomarkers of white matter injury and astrogliosis may be a useful tool to assess myelopathy severity and predict outcome after surgery, while providing valuable information on the underlying pathophysiology.