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!