Background Data: Sickle cell disease (SCD) is the most common inherited blood disease that has obvious effects on the osteoarticular system and the spine. Despite Although vaso-occlusive crises and osteomyelitis are the most frequent complications requiring hospitalization for patients with SCD, the spinal involvement in adult patients with SCD has not been fully explored. Study Design: Retrospective clinical case series. Purpose: To elaborate on various types of spinal affection in adults with SCD and to discuss the effectiveness of conservative management in these patients. Patients and Methods: Between January 2018 and December 2019, a retrospective study was conducted on 21 adults with SCD who presented to the neurosurgery clinic with back pain. The mean age was 27.4±7.84 (range, 17–49) years, while 14 were females and 7 were males. The patients were divided into two groups according to the cause of back pain where Group I (N=12) included the patients who presented with back pain due to SCD related causes like osteonecrosis or infection, while Group II (N=9) included the patients who had back pain due to non-SCD etiologies such as vertebral disc protrusion or facet arthropathy. All patients were offered conservative management as a first-line treatment. Back pain was evaluated using the Wong–Baker Faces Pain Scale. Results: Group I of 12 patients (57.1%) had SCD related causes including 11 patients (91.7%) with vertebral osteonecrosis (4 of them (33.3%) had associated osteoporosis) and one patient (8.3%) with acute lumbar osteomyelitis. Of the 11 patients who presented with osteonecrosis, 7 patients (63.6%) had an acute painful crisis, and the remaining 4 (36.4%) presented with chronic pain due to bone infarcts. In 8 patients (72.7%), the osteonecrosis involved the lumbar spine, while the thoracic and lumbar spines were involved in 3 patients (27.3%). Group II of 9 patients (42.9%) had non-SCD etiologies, including 2 patients (22.2%) who had facet arthropathy, 4 patients (44.4%) disc protrusion, and 3 patients (33.3%) mixed pathology. All patients were managed conservatively. The mean follow-up was 15.2±5.38 (range, 3–24) months. Overall, the mean pre-management Wong–Baker Faces Pain Scale improved from 5.57±1.121 (range, 4–8) to 1.95±0.59 (range, 1–3) at the last follow-up. Conclusion: The most common SCD related spinal pathologies in adults are infarction, infection, and osteoporosis. The majority of SCD patients presenting with low back pain can be managed conservatively regardless of the associated pathology. (2020ESJ202)