Context: Recent literature points towards myelitis, like encephalitis, as a common central nervous system complication of COVID-19. This review elaborates on disorders of the spinal cord caused by the SARS-CoV-2 virus.

Objectives: To review the published data about SARS-CoV-2-associated spinal cord disorders and assess their clinical, neuroimaging, treatment, and prognostic aspects.

Methods: The PubMed and Google Scholar databases were searched for published cases using the search items “COVID-19 OR SARS-CoV-2 AND myelitis”, “COVID-19 OR SARS-CoV-2 AND myelopathy”, and “COVID-19 OR SARS-CoV-2 AND spinal cord”.

Results: Thirty-three isolated cases were included in the present review, of which 14 were aged 60 years and above (range: 3–70 years). Eighteen patients had lung abnormalities on chest imaging. Eight patients had developed either an areflexic paraparesis or quadriparesis. In 17 patients, neuroimaging demonstrated longitudinally extensive transverse myelitis, while 3 cases showed neuroimaging changes in the spinal cord as a part of acute disseminated encephalomyelitis syndrome. Cerebrospinal fluid (CSF) examinations revealed inflammatory changes in 18 patients. However, the SARS-CoV-2 virus in the CSF was discovered in 2 patients. In 2 patients, anti-SARS-CoV-2 antibodies were demonstrated in the CSF. Following treatment, 13 patients were able to walk.

Conclusions: A variety of COVID-19-related spinal cord manifestations, such as acute transverse myelitis, acute necrotizing myelitis, SARS-CoV-2 myelitis, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, hypoxic myelopathy, MOG antibody-associated myelitis, spinal cord infarction, and spinal epidural abscess, have been reported. The possible mechanisms of this involvement being direct invasion, cytokine storm, coagulopathy, and an autoimmune response. However, response to treatment has been generally unsatisfactory, with many patients having residual weakness necessitating long-term rehabilitation.

背景：最近的文献指出脊髓炎，如脑炎，是 COVID-19 的常见中枢神经系统并发症。这篇综述详细阐述了由 SARS-CoV-2 病毒引起的脊髓疾病。

目的：回顾有关 SARS-CoV-2 相关脊髓疾病的已发表数据，并评估其临床、神经影像学、治疗和预后方面的情况。

方法：使用搜索项“COVID-19 OR SARS-CoV-2 AND myelitis”、“COVID-19 OR SARS-CoV-2 AND myelopathy”和“COVID-19”在 PubMed 和 Google Scholar 数据库中搜索已发表的病例或 SARS-CoV-2 和脊髓”。

结果：本次审查纳入了 33 例孤立病例，其中 14 例年龄在 60 岁及以上（范围：3-70 岁）。18 名患者在胸部影像学检查中发现肺部异常。八名患者出现反射性下肢轻瘫或四肢轻瘫。17 例患者的神经影像学显示纵向广泛的横贯性脊髓炎，而 3 例患者的脊髓神经影像学改变为急性播散性脑脊髓炎综合征的一部分。脑脊液 (CSF) 检查显示 18 名患者有炎症变化。然而，在 2 名患者的脑脊液中发现了 SARS-CoV-2 病毒。在 2 名患者中，脑脊液中出现了抗 SARS-CoV-2 抗体。治疗后，13 名患者能够行走。

结论：多种 COVID-19 相关脊髓表现，如急性横贯性脊髓炎、急性坏死性脊髓炎、SARS-CoV-2 脊髓炎、急性播散性脑脊髓炎、视神经脊髓炎谱系障碍、缺氧性脊髓病、MOG 抗体相关性脊髓炎、脊髓炎脊髓梗塞和脊髓硬膜外脓肿已有报道。这种参与的可能机制是直接入侵、细胞因子风暴、凝血病和自身免疫反应。然而，对治疗的反应通常不尽如人意，许多患者仍有残余虚弱，需要长期康复。