Clinical Summary

A previously well, 11-year-old boy, began developing back pain and tripping while playing basketball 3 weeks prior to surgery. Back pain and left leg weakness led to visits with a chiropractor and physiotherapy. This weakness subsequently progressed to involve both legs after 2 weeks and became so severe he required crutches and could not stand without assistance. Urinary incontinence prompted presentation to the emergency department at an outside hospital. Abdominal ultrasound, x-rays of the pelvis and abdomen, and urine studies were performed, and the patient was diagnosed with “slipped capital femoral epiphysis”. An MRI was scheduled, but worsening symptoms including progressive weakness and sensory loss in both legs, as well as urinary incontinence, prompted early re-presentation to the same emergency department. An MRI at that time revealed a well circumscribed 9 x 6 x 6 mm intradural extramedullary mass anterior to the thoracic spinal cord. There was no involvement of the neural exit foramina. The mass was T1 and T2 isointense and demonstrated intense homogenous enhancement. Despite significant compression, only minimal T2 hyperintensity was detected in the adjacent spinal cord.

The patient was transferred to BCCH and underwent surgery involving a T4 laminectomy and decompression. The left T4 pedicle was resected in order to access the tumor. T3-5 posterior instrumentation and fusion was performed to stabilize the spine and a gross total resection was thought to be achieved.

Discussion points

1. Diagnosis?
2. Molecular alteration?
3. Any additional therapy required?