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Scand J Trauma Resusc Emerg Med. 2015 Sep 17;23:65. doi: 10.1186/s13049-015-0143-x.

Does turning trauma patients with an unstable spinal injury from the supine to a lateral position increase the risk of neurological deterioration?--A systematic review.

Author information

Norwegian Air Ambulance Foundation, Department of Research and Development, Drøbak, Norway.
Department of Anesthesiology and Intensive Care, Sørlandet Hospital, Kristiansand, Norway.
The Norwegian Knowledge Center for the Health Services, Oslo, Norway.
Department of Anesthesiology, Oslo University Hospital, Oslo, Norway.
Pre-hospital Critical Care Services, Aarhus, Denmark.
Department of Anesthesiology, Landspitalinn University Hospital, Reykjavík, Iceland.
Faculty of Medicine, University of Oslo, Oslo, Norway.
Air Ambulance Department, Oslo University Hospital, Oslo, Norway.
Network for Medical Sciences, University of Stavanger, Stavanger, Norway.
Department of Anesthesiology and Intensive Care, Stavanger University Hospital, Stavanger, Norway.



Airway protection and spinal precautions are competing concerns in the treatment of unconscious trauma patients. The placement of such patients in a lateral position may facilitate the acquisition of an adequate airway. However, trauma dogma dictates that patients should be transported in the supine position to minimize spinal movement. In this systematic review, we sought to answer the following question: Given an existing spinal injury, will changing a patient's position from supine to lateral increase the risk of neurological deterioration?


The review protocol was published in the PROSPERO database (Reg. no. CRD42012001190). We performed literature searches in PubMed, Medline, EMBASE, the Cochrane Library, CINAHL and the British Nursing Index and included studies of traumatic spinal injury, lateral positioning and neurological deterioration. The search was updated prior to submission. Two researchers independently completed each step in the review process.


We identified 1,164 publications. However, none of these publications reported mortality or neurological deterioration with lateral positioning as an outcome measure. Twelve studies used movement of the injured spine with lateral positioning as an outcome measure; eleven of these investigations were cadaver studies. All of these cadaver studies reported spinal movement during lateral positioning. The only identified human study included eighteen patients with thoracic or lumbar spinal fractures; according to the study authors, the logrolling technique did not result in any neurological deterioration among these patients.


We identified no clinical studies demonstrating that rotating trauma patients from the supine position to a lateral position affects mortality or causes neurological deterioration. However, in various cadaver models, this type of rotation did produce statistically significant displacements of the injured spine. The clinical significance of these cadaver-based observations remains unclear. The present evidence for harm in rotating trauma patients from the supine position to a lateral position, including the logroll maneuver, is inconclusive.

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