The overwhelming majority of patients with back pain have a benign etiology and require nothing more than pain control and time to recover fully. A good emergency medicine physician, however, should always keep in mind the "can't miss" diagnoses and take a careful history focusing on "red flag" symptoms and risk factors. Failure to make the diagnosis in our patient today would result in irreversable paraparesis, incontinence, and impotence. Read on to see why!

A 61 yo male presents to the ED for the second time with complaints of back pain. While the overwhelming majority of cases of back pain are benign, there are a few "can't miss" causes which will result in paralysis if not diagnosed early. You ponder these diagnoses as you make your way to the patient's room...