Nontraumatic spinal emergencies can be caused by a wide spectrum of conditions including infection, hemorrhage, and neoplasm. The most common findings in patients with spinal emergencies are pain, motor deficits, sensory deficits, abnormal reflexes, and urinary dysfunction. Acute back pain is the only symptom of catastrophic spinal emergencies such as spinal hemorrhage or infection. Sudden paralysis can result from trauma, cord infarction, or hemorrhage. Even though a thorough sensory examination in the emergency department is often difficult and unreliable, complexes of sensory and motor abnormalities are helpful. As a result of the anatomical distribution of upper and lower motor neurons, acute spinal cord lesions almost always present with hyperreflexia. The mechanism of urinary incontinence depends on the type of lesion. Spinal cord emergencies frequently go unrecognized initially or are misdiagnosed even with such obvious symptoms as the inability to walk or bladder function failure.