Sickle cell disease of the spine in children

OBJECTIVE: To determine the incidence of back pain in children admitted wit h sickle cell disease so as to increase awareness of this disease in black children presenting with back pain or discomfort. DESIGN: A retrospective review. SETTING: The Children's Hospital of Eastern Ontario in Ottawa, a tertiary c are, university affiliated centre. PATIENTS: Thirty children were treated for active sickle cell disease betwe en 1990 and 1996. Eleven (5 boys, 6 girls) suffered vascular-occlusive phen omena occurring in bone, referred to as "bony crises," requiring a total of 49 admissions. MAIN OUTCOME MEASURES: Clinical manifestations of spinal involvement by sic kle cell disease. MAIN RESULTS: The spine represented the second most common area of bone inv olvement (26%) exceeded only by the knee (35%). The vertebral level affecte d was lumbosacral in 66% of cases, followed by thoracic in 22% and cervical in only 12%. Eighty-six percent of the children with spinal pain were anem ic upon presentation, 71% had an elevated leukocyte count, 15% were hyponat remic and 15% were hyperkalemic. Minimal physical signs in the spine were n oted, other than a local tenderness over the spinous process in 71% and a d ecreased range of back motion in 17%. CONCLUSIONS: Sickle cell disease is becoming more common in Canada as a res ult of increasing immigration from African countries and should always be c onsidered as a possible cause of back pain in a black child.