When are CTOs prescribed How do they work What are the commonly used types of CTOs

CTOs are prescribed when greater motion restriction is desired in the middle and lower cervical spine compared with the restriction achieved with COs. CTOs use chin and occiput fixation attached to the trunk via straps or rigid circumferential supports. Two to four rigid uprights are used to increase stiffness and improve motion control. These designs are generally reported to be more uncomfortable by patients. Common types of CTOs include. TWO-POSTER CTO (Fig. 18-4)

Design. A metal orthosis consisting of single anterior and posterior uprights. Occipital, mandibular, sternal, and thoracic pads are attached. Difficult to use if the patient cannot sit erect Indications. Provision of support following cervical fusion procedures FOUR-POSTER CTO (Fig. 18-5)

Design. Similar to two-poster but with two anterior and two posterior uprights

Indications. Provision of support following cervical fusion procedures

Figure 18-4. Two-poster orthosis.

Design. The sternal occipital mandibular immobilizer (SOMI) derives its name from its points of attachment. It consists of a sternal plate with shoulder components, a waist belt, and occipital and mandibular pads connected by uprights to create a three-post design. A head band may be added and is useful if the chin piece must be temporarily removed due to skin irritation. This orthosis can be more easily fitted to the supine patient than poster type CTOs because the uprights that maintain position of the occipital pad are attached anteriorly to the sternal plate. This brace is not compatible with magnetic resonance imaging (MRI) Indications. Provision of additional support after cervical fusion procedures, immobilization of stable cervical fractures, and as a transition brace after treatment with a halo orthosis ASPEN CTO SYSTEM (Fig. 18-7)

Design. Consists of a CO attached to a thoracic vest via two or four posts Indications. For maximum possible stabilization of the lower cervical and upper thoracic spinal regions. Indicated for minimally unstable fractures

Figure 18-5. Four-poster orthosis.

Figure 18-6. Sternal occipital mandibular immobilizer cervicothoracic orthosis. (From Kim DH, Ludwig SC, Vaccaro AR, et al, editors. Atlas of Spine Trauma. Philadelphia: Saunders; 2008. p. 523.)

Figure 18-7. Aspen cervicothoracic orthosis. (From Kim DH, Ludwig SC, Vaccaro AR, et al, editors. Atlas of Spine Trauma. Philadelphia: Saunders; 2008. p. 95.)

Figure 18-6. Sternal occipital mandibular immobilizer cervicothoracic orthosis. (From Kim DH, Ludwig SC, Vaccaro AR, et al, editors. Atlas of Spine Trauma. Philadelphia: Saunders; 2008. p. 523.)

Design. An occipitocervical support encircles the lower skull and supports the chin and subsequently attaches to an adjustable vest. This orthosis reduces axial load on the cervical spine and provides immobilization across the cervical region, as well as the cervicothoracic junction Indications. Similar to SOMI

Figure 18-8. Minerva cervicothoracic orthosis. (From Kim DH, Ludwig SC, Vaccaro AR, et al, editors. Atlas of Spine Trauma. Philadelphia: Saunders; 2008. p. 96.)
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