Transferring patients with thoracolumbar spinal instability: are there alternatives to the log roll maneuver?

Study Design: Using a cadaveric model, the amount of spinal motion generated during the execution of various prehospital transfer techniques was evaluated using a crossover study design.

Objective: To assess the quantity of segmental motion generated across a globally unstable thoracolumbar spine during the execution of the log roll (LR), lift-and-slide, and 6-plus-person (6+) lift.

Summary Of Background Data: The LR has been reported to be inappropriate for transferring patients with thoracolumbar injuries. Although potentially safer methods have been identified for use with cervical spine injuries, alternatives to the LR have not been recognized in the case of thoracolumbar injuries. METHODS.: Three-dimensional angular motion was recorded across the T12-L2 vertebrae during execution of 3 transfer techniques using cadavers with intact spines and then repeated following an L1 corpectomy. Using a three-dimensional electromagnetic tracking device, the maximum angular motion was measured 3 times for each technique, and the mean value from the 3 trials was included in the statistical analysis.

Results: Statistical tests revealed that there was a significant difference in axial rotation between the LR and lift-and-slide (P = 0.008) but only when these were executed in the presence of a destabilized T12-L1 segment. In addition, analysis of lateral flexion data identified a main effect for technique with the LR generating greater motion than either lifting technique. Finally, no significant difference was noted for flexion-extension among techniques.

Conclusion: The execution of the LR maneuver tends to generate more motion than either of the lifting methods examined in this investigation. More research is needed to identify the safest possible method for transferring or moving patients with thoracolumbar instability.