The following patient presented after being struck by a vehicle as a pedestrian. She presented with very slight neurological signs including some paresthesia into the right index finger and thumb. At the time of her initial examination her deep tendon reflexes were equal bilaterally in the upper and lower extremity. Pathological reflexes were absent. Based on the paresthesia and the the mechanism of injury, she was referred out for MRI of the cervical spine. GOOD THING…this is how it came back. My office called the orthopedic surgeon, she was put on thier schedule the next AM first thing and then had surgery the following morning. IF I WOULD HAVE MISSED THIS I WOULD HAVE LOST MY LICENSE. She had about 1mm of room left for the cord. Clinical Excellent and attention to detail is the ONLY WAY!