serious underlying pathology such an oncologic diagnosis It is also important to assess for associated signs and symptoms Fever may be a sign of an infectious, neoplastic, or rheumatologic etiology of pain Associated numbness, weakness, or incontinence is especially concerning for spinal cord involvement Physical examination In the setting of acute trauma, exclusion of an unstable spinal injury is of paramount concern and supersedes a comprehensive detailed physical examination If signs or symptoms suggest neurologic deficits after trauma, the patient should remain immobilized and timely spine specialist consultation (either neurosurgical or orthopedic) should be sought In the absence of trauma, ascertainment of spinal cord involvement is of utmost importance Weakness, sensory loss, abnormal deep tendon reflexes, saddle anesthesia, and loss of rectal tone suggest spinal cord involvement and potentiate the need for emergent imaging