Background and aims- Recent reports reveal incidences of spinal cord involvement in form of para-infectious or post-infectious myelitis raising potential concerns about the possibilities of SARS-CoV-2 behind the pathogenesis of spinal cord demyelination. In this study, we intend to summarise so far available pieces of evidence documenting SARS-CoV-2 mediated spinal demyelination in terms of clinical, laboratory parameters and imaging characteristics. Methodology- This review was carried out based on the existing PRISMA (Preferred Report for Systemic Review and Meta-analyses) consensus statement. Data was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase and Cochrane library and Preprint servers up till 10th September, 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes "SARS-COV-2", "COVID-19", "demyelination" etc. Results- A total of 21 cases were included from 21 case reports after screening from various databases and preprint servers. Biochemical analysis reveals that the majority of cases showed elevated CSF protein as well as lymphocytic pleocytosis. Interestingly, a majority of cases were found to be associated with long extensive transverse myelitis (LETM), and remaining cases were found to be associated with isolated patchy involvement or isolated short segment involvement or combined LETM and patchy involvement. Few cases were also found with significant co-involvement of the brain and spine based on the imaging data. Conclusion- It can be interpreted that SARS-CoV-2 may play a potential role in spinal demyelinating disorders in both para-infectious and post-infectious forms.

中文翻译：

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脊髓累及COVID-19的频谱：系统评价

背景与目的-最近的报道揭示了脊髓感染以副感染性或感染后性脊髓炎的形式发生，引发了人们对SARS-CoV-2在脊髓脱髓鞘发病机理背后的可能性的担忧。在这项研究中，我们打算总结到目前为止可利用的证据，从临床，实验室参数和影像学特征方面证明SARS-CoV-2介导的脊髓脱髓鞘。方法-这项审查是根据现有的PRISMA（系统审查和荟萃分析的首选报告）共识声明进行的。截至2020年9月10日，数据已从四个数据库收集：Pubmed / Medline，NIH Litcovid，Embase和Cochrane库以及Preprint服务器。搜索策略由相关医学主题词中的一系列关键字组成，包括“ SARS-COV-2”，“ COVID-19”，“脱髓鞘”等。结果-从21例病例报告中筛选出21例病例各种数据库和预印服务器。生化分析表明，大多数病例显示CSF蛋白升高以及淋巴细胞性细胞增多。有趣的是，发现大多数病例与长距离广泛性横贯性脊髓炎（LETM）有关，而其余病例则与孤立的斑块状受累或孤立的短节段受累或LETM和斑块状受累合并在一起。根据影像数据，也很少发现大脑和脊柱有明显的共同累进的病例。