A 25-year-old man was snowboarding down a slope and attempted to perform a trick off a ramp. He miscalculated the jump and landed directly on his head, without a helmet. He denied any loss of consciousness but immediately had difficulty moving his arms and legs. The ambulance crew placed him supine on a board with a hard cervical collar and blocks. In the emergency department, he is alert and oriented to person, place, and time, but he complains of severe neck pain. His heart rate is 80/min, blood pressure is 130/85 mmHg, respiratory rate is 13/min, and temperature is 37.4 °C. He has 2/5 strength in his upper and lower extremities. He reports decreased sensation to pinpricks and cold packs in all extremities but has preserved sensation to deep touch and pressure throughout the body. He has nonsustained clonus and brisk reflexes in his biceps, brachioradialis, triceps, patellar tendons, and Achilles tendons. His big toe points upward with all other toes fanning out when the sole of his foot is stimulated with a blunt instrument. Rectal examination reveals preserved anal tone. His imaging is shown below (◘ Fig. 28.1).