A 6-year-old girl was unable to walk due to pain in her back. After she was taken to Johns Hopkins Children’s Center, imaging showed a large mass filling the spinal canal and pushing out the spinal roots at L4–L5. Alan Cohen, director of pediatric neurosurgery at Johns Hopkins, resected the tumor using the operating microscope, intraoperative ultrasonography and neuromonitoring. Pathology identified the mass as a rare spinal epidermoid tumor, also referred to as a “pearly” tumor.