William Rowell compares the potential outcomes of different ways to manipulate patients who have suspected spinal or pelvic injuries

Spinal injury can result in morbidity and mortality. Research suggests that only a small percentage of patients assessed for spinal fracture have sustained the injury, however, and even fewer have unstable fractures. Protection of the spine and spinal cord is critically important and although many trauma patients leave hospital having had no spinal trauma, despite their mechanism of injury, most arrive with spinal precautions in place. Such patients must be moved and it is common practice to do this using the log-roll procedure. This article examines the literature on spinal motion during the log-roll procedure and transfer devices, and asks if there is still a place for the manoeuvre in modern trauma practice.