Clinical Reasoning: A man with rapidly ascending paralysis

A 38-year-old construction worker with no medical history presented with back pain, urinary retention, and flaccid lower extremity paralysis. Three weeks prior to presentation, he fell from a ladder with no immediate injury. Two weeks after the fall, he presented to another hospital for back pain and urinary retention. MRI of the lumbar, cervical, and thoracic spine without contrast were reportedly normal, and his back pain improved with an oral methylprednisolone dose pack (figure). The urinary retention remained, and he was discharged with an indwelling catheter. Within a week of the initial urinary symptoms, he developed ascending lower extremity numbness and paralysis, and was seen emergently at our hospital.