A 13-year-old boy with a 1-year history of low-back pain had sudden worsening of pain while at a school dance. Results of physical examination, including the neurologic examination, were normal on admission, yet the patient's pain was severe enough to require morphine. No systemic symptoms were present, and he had no history of trauma. Results of laboratory studies were within normal limits. Roentgenograms of the spine showed abnormal sclerosis of vertebrae L-3 and L-4. A nuclear bone scan showed increased uptake of tracer in these locations. A magnetic resonance image of the lumbar spine confirmed the abnormality in two adjacent vertebral bodies and showed the intervening disk to be normal. An epidural mass was also demonstrated on the magnetic resonance image.
Results of a needle biopsy were negative, but a subsequent open biopsy was performed that was diagnostic. Three weeks later, an L-3 to L-4 vertebrectomy was performed with spinal