Sickle cell disease of the spine in children.

OBJECTIVE

To determine the incidence of back pain in children admitted with 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 care, university affiliated centre.

PATIENTS: Thirty children were treated for active sickle cell disease between 1990 and 1996. Eleven (5 boys, 6 girls) suffered vascular-occlusive phenomena occurring in bone, referred to as "bony crises," requiring a total of 49 admissions.

MAIN OUTCOME MEASURES: Clinical manifestations of spinal involvement by sickle cell disease.

MAIN

RESULTS

The spine represented the second most common area of bone involvement (26%) exceeded only by the knee (35%). The vertebral level affected 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 anemic upon presentation, 71% had an elevated leukocyte count, 15% were hyponatremic and 15% were hyperkalemic. Minimal physical signs in the spine were noted, other than a local tenderness over the spinous process in 71% and a decreased range of back motion in 17%.

CONCLUSIONS

Sickle cell disease is becoming more common in Canada as a result of increasing immigration from African countries and should always be considered as a possible cause of back pain in a black child.