Acute lymphoblastic leukemia (ALL) is considered the most common tumor in pediatric age groups accounting for 30% of all the cancers [2].

Clinical manifestation of ALL is initially due to bone marrow infiltration as a reduction in hematopoietic activity [2]. ALL can present as “extramedullary leukemia” if it is localized into internal organs such as lymph nodes, spleen, the liver, and the central nervous system [2, 7].

Patients with prominent bone pains and normal hematological values cause a delay in their diagnosis [2].

A study conducted on 296 children with acute lymphoblastic leukemia (ALL) showed that 60% of them did not experience bone pain, 22% had some bone pain, and 18% had severe bone pain. The study revealed significant differences in the initial hemoglobin levels, total leukocyte count, absolute neutrophil count, platelet count, and the percentage of circulating blasts among these three groups of patients [8].

We have not found any prior reports of vertebral compression fractures being the only symptoms before the diagnosis of ALL in this age group. However, it is important to note that both the CBC and blood film showed no abnormalities. These findings suggest that further research is required to identify other possible early indicators of ALL [9].

Rare cases of ALL presenting with severe osteoporosis and spontaneous humerus fractures have also been described [9].

Typically, this type of fracture is caused by minor trauma that generally would not inflict the level of damage observed. Everyday activities, such as coughing, standing up, or bending over, can fracture a bone that has been weakened by an illness [1].

MRI is highly sensitive to changes in bone marrow composition and plays a role as a modality to confirm hematological malignancies. Furthermore, its role in monitoring response to treatment as well as in diagnosing complications is well established [10].

Following an MRI of the spine for back pain, our patient received a diagnosis of leukemia after the results showed some concerning signs. The diagnosis was then confirmed through a bone marrow aspirate and biopsy.