Investigating Spine and Spinal Cord Complications of COVID-19
Authors:   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran, AND Shiraz Neuroscience Research Center, Shiraz University of Medical Science, Shiraz, Iran, Mousavi Seyed Reza , Farrokhi Majidreza ,   Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran, AND Shiraz Neuroscience Research Center, Shiraz University of Medical Science, Shiraz, Iran, Kalani Navid ,   Department of Anesthesiology, Critical Care and Pain Management Research Center, Jahrom University of Medical Sciences, Jahrom Iran, Mosalanezhad Tina ,   Medical Student, Jahrom University of Medical Sciences, Jahrom, Iran, Karimi Fatemeh ,   Histomorphometry and Stereology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran AND Department of Anatomy, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran, Eilami Owrang ,   Department of Family Medicine, School of Medicine HIV/AIDS Research Center, Research Institute for Health, Namazi Teaching Hospital, Shiraz University of Medical Sciences, Shiraz, Iran, Kazeminezhad Ali ,   Department of Neurosurgery, Peymanieh Hospital, Trauma Research Center, Jahrom University of Medical Sciences, Jahrom, Iran
Published: December 2023

Background and Aim: SARS-COV-2 can present with pulmonary, renal, gastrointestinal, hematological, and neurological manifestations. Neurological manifestations may occur after or before COVID-19 symptoms and signs. Spine and spinal cord complications are documented as neurological complications of COVID-19. Spinal cord pathology following COVID-19 showed inflammatory myelopathy and suspected cord ischemia. The most frequent presentation of COVID-19 myelitis is non-enhancing central expansile cord T2 signal changes, but it can present with lateral and dorsal column-specific disease and in some cases with negative magnetic resonance imaging (MRI). There is no known documented mechanism for spinal cord involvement in COVID-19 infection, but it seems as a post-infectious immunological and post-inflammatory disorder and reaction. Viral infection of SARS-CoV-2 can cause demyelination of the brain and spinal cord and also can exacerbate the known primary demyelinating disorders. Methods and Materials/Patients: This is a narrative study about the spinal cord complications of COVID-19. To provide up-to-date information, we precisely reviewed COVID-19 articles on spine and spinal cord complications. Based on the keywords COVID-19, SARS-CoV-2, spine, and spinal cord, all the related articles were taken from Google Scholar, PubMed, and Medline and were precisely studied. Results: There are reported cases of COVID-19 spine and spinal cord involvement. There is no documented mechanism for these involvements but the possible mechanisms are direct invasion, cytokine storm, coagulopathy, and an autoimmune response. The routine therapy of such complications is the treatment of these complications with other primary causes with a poor and unsatisfactory response of myelopathy to treatment; however, early diagnosis and vigilance of such involvement improve outcome. Conclusion: COVID-19 can cause spine and spinal cord complications in some patients without a known incidence rate of such complications. The pathogenesis is not completely known; therefore, more conclusive studies are obligatory to improve our information on COVID-19 spinal cord and spine complications.