Neither study showed any anterior spinal involvement. The patient was taken immediately to the operating room where a decompression was performed. A post- operative CT scan revealed some remaining tumor present in the remaining portion of the posterior elements. He recognized that he did not have a stable situation and asked for consultation. With the spine being unstable and with so much bone having been resected, choices are limited.
Stability is of paramount concern.
Discussion Randal R. Betz, MD Shriners Hospital, Philadelphia, PA Neurogenic scoliosis can be difficult to diagnose because often in the early stages there are no abnormal neurologic findings. The presence of cerebral palsy complicates this case, in that conducting a neurologic exam and looking for subtle abnormal findings may have been extremely difficult. It is essential in any initial evaluation of scoliosis that the surgeon have access to good quality radiographs, and Figure 1 does not show enough bony detail to rule out a spinal lesion. This patient did not fit either of those criteria. When confronted with a mass at the L1-L2 level, the highest likelihood is an aneurysmal bone cyst.