From Medical History

Minor trauma or even strenuous lifting (in an older or potentially osteoporotic patient.)

History of cancer.

Constitutional symptoms, such as recent fever, chills, or unexplained weight loss.

Risk factors for spinal infection: recent bacterial infection (e.g. urinary tract); IV drug abuse; or immune suppression (from steroids, transplant, or HIV).

Pain that worsens when supine; severe nighttime pain.

Recent onset of bladder dysfunction, such as urinary retention, increased frequency, or overflow incontinence.

Severe or progressive neurologic deficit in the lower extremity

From Physical Examination

Perianal/perineal sensory loss.

Major motor weakness: quadriceps (knee extension weakness); ankle plantar flexors, evertors, and dorsiflexors (foot drop).