Which crash scenario constitutes a positive indication for spinal motion restriction?

• A. Auto vs pedestrian/bicyclist thrown, run over or with significant (>20 mph) impact
• B. Rear-end collision with minor damage
• C. Non-collision bicycle crash
• D. Vehicle roll-over without occupants

Answer: (D)

High-energy crash mechanisms raise suspicion for spinal injury and prompt spinal motion restriction. A vehicle roll-over is a classic high-energy event because it involves rapid deceleration, complex vehicle dynamics, and potential axial loading on the spine as occupants are jolted or ejected. This makes spinal injury more likely, so applying spinal motion restriction is indicated if occupants were or could have been present. The other scenarios describe lower-energy or non-collision events, which carry less inherent risk for spinal injury unless other signs or symptoms are present.