key: cord-027854-o511h1my authors: Moscote-Salazar, Luis Rafael; Galindo-Velasquez, Hather; Garcia-Ballestas, Ezequiel; Agrawal, Amit; Rahman, Md Moshiur; Sarwar, A.S.M. title: Letter to the Editor: SARS-CoV-2 and Traumatic Cervical Acute Spinal Cord Injury: An Appraisal date: 2020-06-25 journal: World Neurosurg DOI: 10.1016/j.wneu.2020.06.134 sha: doc_id: 27854 cord_uid: o511h1my nan This year, 2020, has been the start year of the first pandemic of the century. The outbreak was caused by viruses of the Coronaviridae family, currently called SARS-CoV-2. 1 It produces a severe inflammatory syndrome and involving multiple organs, it has been established that this pathogen also affects the central nervous system and the spinal cord. 2 It has been recognized that approximately 60-70% of the world population will be infected. 3 The cervical spine is an area susceptible to injury caused by trauma. It is estimated that approximately 4/100,000 people have a spinal injury. In the United States, approximately 12,000 people suffer from spinal injuries with the respective neurological sequelae. The neurotropic potential of the coronavirus has been widely suggested. 4 Demyelination areas have been found in the spinal cord using Magnetic Resonance Imaging (MRI). 5 It has been suggested that the virus triggers a neurotoxic hypoxic injury that can aggravate it in patients with a spinal injury. In patients infected with coronavirus and suffering from a traumatic spinal injury. As we found in evidence, a spinal cord injury is a dynamic process, where a cascade of events in the pathophysiology is critical in the deterioration of the clinical scenario of a patient. We have to remember the importance of neurogenic shock, defined as the autonomic dysregulation due to the sudden loss of control of the sympathetic tone and the overlapping of a parasympathetic response that appears in the context of a spinal cord injury. It seems that patients with trauma above the level of T4 are at higher risk of triggering the appearance of this shock than in other segments of the spinal column. 6, 7 An initial management on the site of a traffic accident by using rigid collars and spine immobilization is recommended steps by the Advanced Trauma Life Support (ATLS) algorithms to prevent cervical spine displacement causing more damage and irreversible sequelae. 8 Due to the decrease in systemic vascular resistance preventing the vital organs to obtain the requirements of blood, an early identification followed by an aggressive treatment is the key to avoid secondary spinal injury. 9 SARS-CoV-2 can contribute to neurological abnormalities during infection, with severity depending on NeuroCovid staging. 10 There is a link between the response of the immune system in spinal cord injury, and how it contributes to neuronal and oligodendrocyte apoptosis and axonal demyelination. 11 Regarding the latter, it should be thoroughly investigated what is the actual role of the virus during the pathophysiology of the acute spinal cord injury and how it can affect the outcomes, and prognosis of the patient. A novel coronavirus from patients with pneumonia in China Emergency department evaluation and treatment of the neck and cervical spine injuries Merkel Gives Germans a Hard Truth About the Coronavirus -The New York Times Neurotropism of SARS-CoV 2: Mechanisms and manifestations SARS-CoV-2 can induce brain and spine demyelinating lesions Emergency Neurological Life Support: Traumatic Spine Injury Presentation of neurogenic shock within the emergency department Early neurological care of patients with spinal cord injury Neurobiology of COVID-19. J Alzheimer's Dis A Review on Response of Immune System in Spinal Cord Injury and Therapeutic Agents useful in Treatment The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: