Neurologic complications of sickle cell anemia are most commonly ischemic strokes secondary to sludging in cerebral arterioles. We, therefore, report a case of progressive paraparesis in a child with sickle cell anemia which was initially thought to be secondary to a spinal cord ischemic event. Further diagnostics demonstrated that the neurologic deficits were secondary to salmonella osteomyelitis and an epidural abscess, compressing the upper thoracic spinal cord at the T6 level. The diagnostic and radiological features which help to distinguish between bone infarct and osteomyelitis, both responsible for bone pain in sickle cell patients, are also presented. In particular, Tc-sulfur colloid bone marrow imaging is the most helpful test for distinguishing between these similarly presenting clinical entities, as early as 48 h after bone pain develops.