1. Radiological Findings

Based on the provided images (including cervical spine CT and MRI) and the patient's clinical symptoms, the following main features are observed:

• CT scan: No clear vertebral fracture or significant bony destruction is identified in the cervical spine sequence, and the vertebral alignment is basically intact. Some intervertebral spaces are slightly narrowed, suggesting possible degenerative changes. No obvious bony compression of the spinal canal or pedicle destruction is noted.
• MRI (T2-weighted imaging): A local high signal change is visible within the cervical spinal cord at the lower cervical vertebrae level (indicated by the red and yellow arrows), indicating possible spinal cord edema or contusion; no obvious fractured fragment compressing the spinal cord is observed. Mild degenerative signal changes in the local intervertebral discs are also noted.
• Others: No significant paravertebral soft tissue swelling or obvious ligament tear sign. The general shapes of local muscles, ligaments, and surrounding soft tissues appear intact.

2. Possible Diagnoses

Considering the patient's acute paraplegia (paralysis of both lower extremities) following a fall, absence of obvious fractures or structural abnormalities on CT, but with abnormal spinal cord signals on MRI, the following potential diagnoses are considered:

1. SCIWORA (Spinal Cord Injury Without Radiographic Abnormality): This refers to spinal cord injury despite no apparent structural abnormalities on plain X-ray or CT. Such an injury can be caused by a momentary hyperextension, hyperflexion, or other mechanisms of spinal cord trauma.
2. Spinal cord contusion or edema (acute phase): Although categorized under spinal cord injury similar to SCIWORA, minute fracture lines or ligament instability may be very subtle, making imaging findings inconspicuous.
3. Other less common conditions: Such as micro-cracks within the vertebral body or mild disk tear. However, these are usually more evident on CT or MRI scans, so their likelihood is comparatively low.

3. Final Diagnosis

Considering the patient's age, sudden lower extremity paralysis after a fall, no structural fracture or notable abnormality on CT, and the appearance of abnormal spinal cord signals on MRI, the most likely diagnosis is:

• SCIWORA (Spinal cord injury without radiographic abnormality), i.e., spinal cord contusion/edema.

If new symptoms occur subsequently or if there is a need to exclude ligament or facet joint complex injuries, higher-resolution MRI sequences or, if necessary, dynamic imaging studies could be considered to evaluate potential spinal instability.

4. Treatment Plan and Rehabilitation Program

Given that the patient currently presents with cervical spinal cord injury and paraplegic symptoms, the treatment goals include:

1. Acute phase management:
   • Appropriate immobilization of the cervical spine to prevent secondary injury.
   • If significant inflammatory response or edema is present, consider corticosteroid pulse therapy (e.g., methylprednisolone), but evaluate benefits and risks on an individual basis.
   • Closely monitor neurological function and watch for any complications.
2. Surgical indications:
   • If spinal instability is discovered or structural abnormalities causing nerve compression develop later, surgical decompression or internal fixation may be required.
   • Currently, CT and MRI reveal no obvious vertebral displacement or visible compression, so conservative treatment and observation are recommended.
3. Rehabilitation and exercise prescription:
   • Early rehabilitation (bedridden phase):
     1. Maintain the spine in a neutral position, using an appropriate neck brace or support.
     2. Under the guidance of a specialist or physical therapist, perform passive range-of-motion exercises to prevent soft tissue contractures.
     3. Pay attention to turning in bed and changing positions to prevent pressure sores.
   • Intermediate rehabilitation (sitting and standing training phase):
     1. When neurological function stabilizes, attempt sitting balance training, gradually progressing to assisted standing (using bedside support or a walker).
     2. Follow the FITT-VP principle (Frequency, Intensity, Time, Type, Volume, Progression), starting at low intensity and short duration, then progressively increasing activity.
     3. Gradually incorporate core and upper extremity strength training to support the trunk and aid in transfers.
   • Late rehabilitation (walking and functional training phase):
     1. If lower extremity motor function gradually recovers, engage in gait and balance training under the guidance of a physical therapist.
     2. For insufficient lower extremity strength, use exercises such as cycling or resistance band workouts with a progressive increase in resistance.
     3. Combine with activities of daily living training to improve independent walking and functional abilities.

During the entire rehabilitation process, closely monitor the stability of the patient’s spine and changes in neurological function, and adjust the treatment plan accordingly. If there is osteoporosis or other degenerative skeletal factors, provide nutritional support, bone density management, and psychological counseling as part of comprehensive therapy.

Disclaimer

This report is a reference analysis based on current imaging and clinical information. It does not replace a face-to-face professional diagnosis or treatment recommendation by a medical doctor. If the condition changes or there are any questions, please seek medical attention or consult a specialist.