"Tower vertebra": a new observation in sickle cell disease

Abstract

A total of eight patients (14%) displayed infarcted vertebrae with compensatory vertical growth of at least one adjacent vertebrae. These resemble the elongated vertebral bodies associated with other conditions. We can find no prior report of this finding in association with sickle cell anemia.

Morphometry of the thoracolumbar vertebrae in sickle cell disease

“…These include demineralization, generalized infarction with increased density, and changes in vertebral bodies due to ischemia. 2 Patients may develop vertebral collapse, either from osteoporosis or as a result of vertebral infarction and marrow hyperplasia. As the erythroid mass increases in the marrow, it displaces trabecular bone.…”

“…2 In addition to marrow hyperplasia, local anoxic events may lead to premature closure of the epiphyses and impaired, or even asymmetrical, growth of the long bones of the limbs. 12 For this reason, the transverse and cephalocaudal diameters of the right and left pedicles may not be similar in the same vertebra.…”

Bone involvement in sickle cell disease

“…Marrow hyperplasia can cause ischaemia of the central portion of the vertebral growth plate, leading to disturbance of vertebral growth and resulting in the characteristic ‘H’ shaped vertebrae because of squared‐off depression of the vertebral end plates (Reynolds, 1987; Williams et al , 2004a). Alternatively, some female patients with sickle cell disease develop ‘tower’ vertebrae in which there is an increase in the height of the vertebral bodies without an associated increase in the girth, again postulated to be a consequence of chronic marrow hyperplasia (Marlow et al , 1998). In addition to marrow hyperplasia, local anoxic events may lead to premature closure of epiphyses and impaired or even asymmetrical growth of the long bones of the limbs (Collett‐Solberg et al , 2002).…”

Sickle Cell Anemia

“…This appearance is seen in approximately 10% of patients, but it is essentially pathognomonic for SCA and has been called the Lincoln log or H-shaped vertebra deformity (Fig 11) (19). Overgrowth in height of at least one adjacent vertebral body has been noted in adults with infarcted vertebral bodies (43).…”