An extramedullary hematopoietic lesion causing acute lumbar stenosis in the setting of sickle cell anemia: a case report and review of the literature.

Background: Neurological compromise due to extramedullary hematopoiesis is a rare occurrence, typically associated with myeloproliferative disorders such as thalassemia or hereditary spherocytosis. Few cases have been reported in the setting of sickle cell anemia, and there is no established consensus on optimal treatment. Management strategies range from exchange transfusion to radiotherapy and surgical decompression. This case report presents a rare case of stenosis compression caused by extramedullary hematopoiesis in a patient with sickle cell anemia and highlights the therapeutic efficacy of low dose radiotherapy as a non-surgical, stand-alone intervention. Case Description: We report the case of a 52-year-old female with known sickle cell anemia who presented with acute L2-3 stenosis and radiculopathy due to an epidural lesion caused by extramedullary hematopoiesis. She experienced progressively worsening low back pain, right anterolateral thigh numbness, and motor weakness over several days, refractory to conservative analgesics. Magnetic resonance imaging (MRI) confirmed the diagnosis, and she was treated with radiation therapy, leading to a complete resolution of neurologic symptoms and radiographic findings on MRI within 3 months. Conclusions: Cases of successfully treated neurologic compression from extramedullary hematopoietic deposits in the setting of sickle cell anemia are exceedingly rare. This case highlights the efficacy of radiotherapy as a standalone treatment, demonstrating an optimal outcome without the need for surgical intervention.