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Sickle cell disease of the spine in children
1Division of Pediatric Orthopedics, Children's Hospital of Eastern Ontario, University of Ottawa.
Insights
Sickle cell disease commonly causes back pain in children, particularly affecting the lumbosacral spine. Increased awareness is crucial for diagnosing this condition in black children presenting with back pain.
Area of Science:
- Pediatric Hematology
- Orthopedic Surgery
- Vascular Medicine
Background:
- Sickle cell disease (SCD) is a genetic blood disorder.
- Vascular-occlusive phenomena, or bony crises, are common complications of SCD.
- Back pain can be a presenting symptom in children with SCD.
Purpose of the Study:
- To determine the incidence of back pain in children admitted with sickle cell disease.
- To increase awareness of SCD as a cause of back pain in black children.
Main Methods:
- A retrospective review of 30 children treated for active SCD between 1990 and 1996.
- Analysis of clinical manifestations of spinal involvement in children with SCD.
- Review of patient data including demographics, clinical presentation, and laboratory findings.
Main Results:
- The spine was the second most common site of bone involvement in SCD (26%), after the knee (35%).
- Lumbosacral involvement was most frequent (66%), followed by thoracic (22%) and cervical (12%).
- Children with spinal pain often presented with anemia (86%) and elevated leukocyte count (71%).
Conclusions:
- Sickle cell disease should be considered in the differential diagnosis of back pain in black children.
- The increasing prevalence of SCD in Canada necessitates greater clinical awareness.
- Early recognition and diagnosis of SCD-related back pain can improve patient outcomes.
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.