Is the log-roll still safe? A systematic review of patient transfer techniques in traumatic spinal cord injury

To systematically synthesizes current biomechanical and available clinical evidence regarding the log-roll manoeuvre in adult patients with suspected or confirmed traumatic spinal cord injury (TSCI), and to compare it with alternative patient transfer techniques.

The log-roll manoeuvre has long been incorporated into trauma care to facilitate posterior examination, hygiene, and patient transfer. However, emerging biomechanical research has raised concerns about the magnitude of spinal motion generated during this manoeuvre, particularly in simulated unstable injury models.

Systematic review conducted in accordance with PRISMA 2020 guidelines.

Electronic searches were performed in PubMed, Embase, CINAHL, and the Cochrane Library (January 2010-March 2024). Studies evaluating the log-roll manoeuvre and reporting quantitative biomechanical or clinical safety outcomes were included. Methodological quality was appraised according to study design, and levels of evidence were assigned using the Oxford Centre for Evidence-Based Medicine framework. Due to heterogeneity in study designs and outcome measures, findings were synthesised narratively.

Ten studies met inclusion criteria, comprising predominantly cadaveric biomechanical investigations and a limited number of observational studies. Across unstable spine models, the log-roll manoeuvre consistently generated greater angular and translational displacement compared with several alternative transfer techniques, including lift-and-slide methods and mechanical transfer devices. However, no included primary studies directly demonstrated neurological deterioration attributable to the log-roll manoeuvre. Direct prospective clinical outcome data were limited.

Current biomechanical evidence suggests that the log-roll manoeuvre may not represent the lowest-motion transfer technique in simulated unstable spinal conditions. Nevertheless, direct clinical evidence linking log-roll manoeuvres to neurological worsening remains insufficient. A context-sensitive and evidence-informed approach to patient transfer is therefore recommended.

Clinical decision-making should balance biomechanical considerations, diagnostic needs, resource availability, and operational feasibility. Where feasible, alternative transfer methods associated with reduced motion in experimental models may be considered. Ongoing education, interprofessional training, and periodic review of institutional protocols may support safer patient handling in trauma care.