History is as mentioned previously.  A thorough neurologic exam is important. Observe for voluntary and involuntary movements, or lack thereof, which may help localize the level of injury (i.e. paralysis, respiratory patterns). Motor and sensory examinations also help pinpoint the level of injury.  Determine the location of the patient’s pain, if any is present.  Palpate the entire spine for a step-off (“gibbus”) deformity or a wide interspinous space.