Spinal cord maladies occupy a uniquely perilous corner of emergency medicine. The challenge is that spinal cord pathologies often present subtly, with nonspecific and evolving symptoms such as atraumatic back pain, urinary retention, minimal leg weakness, or imbalance, all of which can easily be dismissed or attributed to an alternative diagnosis at initial presentation. Because early symptoms are often not pronounced or yet definitive, it is essential to recognize deviations from expected patterns of more benign disease, perform detailed history and physical examination, and act on atypical findings to minimize diagnostic errors.