Subacute progressive ascending myelopathy is a rare condition complicating spinal cord injury, unrelated to mechanical compression, instability, hemorrhage or syrinx formation. Clinically, ascending neurological deficit may extend at least two segments above the level established at the initial insult within the first 3 weeks of the initial spinal cord insult. MR imaging characteristically demonstrates cord changes ascending at least four vertebral levels above the initial injury site. The development of progressive myelopathy is a dreaded complication of spinal cord injury and is not misunderstood for post-op complication. We describe a case of a 29-year-old male patient who suffered a falling down accident. He initially presented with a T12 vertebral fracture with associated cord compression and signal changes in the spinal cord. During the subsequent 3 weeks, he developed progressive sensory changes with cord signal abnormalities on magnetic resonance imaging extending above from the injury site. (J Korean Acad Rehab Med 2010; 34: 595-598)