Cervical Orthoses Cervico thoracic Orthoses

Cervical Orthoses, Cervico thoracic Orthoses -

Cervical Orthoses Cervico thoracic Orthoses

Spinal bracing continues to be a mainstay of treating deformity as well as management of acute and chronic spinal injuries.

Orthotics can be broadly categorized based on the region they are employed to immobilize: cervical (CO), cervicothoracic (CTO), thoracolumbosacral (TLSO), lumbosacral (LSO), and sacroiliac (SIO).

Key Advances in Spinal Orthotics: Understanding Biomechanics and Material Innovations

Advances in Spinal Biomechanics: The spine is viewed as a series of semi-rigid segments interconnected by viscoelastic linkages. It involves motion in six degrees of freedom, including rotation around three axes and translation along three coordinates. This complex understanding of dynamics is crucial for the design and application of orthotics.

Evaluation of Orthotic Efficacy: A variety of methods such as standard radiography, cineradiography, and goniometry are used to assess the effectiveness of orthotics in restricting spinal movement. These techniques accurately measure spinal motion and vary in their degree of radiation exposure.

Challenges in Orthotic Design: The design must consider regional variations of surrounding anatomical structures, such as soft tissues of the neck, thoracic cavity, and pelvis. These areas' distinct characteristics are vital for the effectiveness and comfort of the orthosis.

Soft Tissue Pressure Measurement: Measuring pressure on soft tissues can be a method to assess the fit of a spinal orthosis, although its role in assessing corrective force remains somewhat unclear.

Advancements in Materials and Manufacturing Techniques: The use of new composite materials, polymer resins, and thermoplastics has significantly enhanced the lightness and comfort of orthoses. This is a notable improvement for patients who require long-term orthotic support.

Computer-Aided Design and Manufacturing (CAD/CAM): The application of CAD/CAM technology allows for the rapid and precise production of personalized orthoses. This technology enables the design of suitable orthoses quickly based on specific measurements and body types of patients, reducing production time and improving fit.

Application of 3D Imaging Technology: The development of handheld three-dimensional laser scanners further optimizes the customization process of orthoses by accurately capturing the patient's body shape for designing more suitable orthoses.

Overall, these advancements indicate that the design and manufacturing of spinal orthoses are becoming more efficient, precise, and personalized, which is significant for improving patient comfort and therapeutic effectiveness.


Understanding Cervical Orthoses: Types and Applications in Neck Injury Management

Cervical Orthoses, essential in the field of spinal support and rehabilitation, are classified into two primary categories: soft and hard. These devices play a crucial role in the management and treatment of various neck conditions and injuries.

Soft Cervical Orthoses: These are commonly known as soft collars. Their main function is not to immobilize the neck completely but to provide a degree of support. They are particularly useful in treating injuries like whiplash, where complete immobilization is not necessary. Soft collars offer comfort and proprioceptive feedback, which helps patients to self-regulate and limit their neck movement voluntarily. In some cases, soft cervical collars are also used in managing cervical myelopathy, although their use in such conditions is subject to debate among medical practitioners.

Hard Cervical Orthoses: This category is subdivided into two types - cervical orthoses and cervicothoracic orthoses.

Cervical Orthoses (COs): These are designed to provide more rigid support and immobilization of the cervical spine compared to soft collars. They are used when a greater degree of stabilization is needed, such as in more severe injuries or post-surgery.

Cervicothoracic Orthoses (CTOs): These extend the support further to include both the cervical and upper thoracic regions. CTOs are employed in situations requiring immobilization and alignment of the upper spine, including the neck and the upper back.

All hard orthoses, whether cervical or cervicothoracic, are designed with careful consideration of the vital soft tissue structures in the neck area. They typically have firm seating around the base of the skull and upper thorax, connected by a rigid column to ensure effective immobilization of the cervical spine. Most of these orthoses also feature an anterior opening to accommodate a tracheostomy tube if necessary.

In summary, cervical orthoses, whether soft or hard, are vital tools in the management of neck injuries and conditions, offering varying degrees of support and immobilization based on the specific medical requirements of the patient.


cervical orthosiscervical orthosis design includes anterior and posterior shells with a soft lining that can be changed for hygiene purposes. Design tabs which allow the collar to better conform to the patient when tightened


Evaluating the Efficacy and Challenges of Cervical Orthoses in Spinal Immobilization


A landmark study conducted by Gdpson and colleagues in 1967 profoundly impacted our understanding of cervical orthoses. This research meticulously evaluated various types of orthoses, including the soft collar, Philadelphia collar, four-poster orthosis, sterno-occipital mandibular immobilizer (SOMI), and cervicothoracic orthosis, in their effectiveness at immobilizing the cervical spine.

Methodology: The study employed radiographs and overhead photographs to observe the extremes of motion in flexion-extension, rotation, and lateral bending. It uniquely quantified the sagittal plane motion for each brace at every cervical spine level.


Effectiveness of Different Orthoses: The study revealed that the soft collar provided no significant restriction of motion in any plane. In contrast, orthoses with greater length (extending onto the thorax) and rigidity showed improved control in flexion. However, these orthoses were less effective in controlling lateral bending and total flexion-extension motion.

Paradoxical Motion: A notable observation was the increased motion between the occiput and C1 in all braced conditions compared to the unbraced state. This phenomenon, termed “snaking” or paradoxical motion, has been observed in both the cervical and thoracolumbar spine in subsequent studies.


Skin Breakdown: A known complication of wearing cervical orthoses is skin breakdown, particularly over bony prominences like the occiput, mandible, and sternum. This risk is heightened in polytrauma patients with prolonged recumbency and those with altered sensorium.

Clinical Implications:

Importance of Proper Fit: Achieving a proper fit is crucial, yet challenging due to the diversity of body shapes. An appropriately fitted brace is essential not only for effective immobilization but also to minimize the risk of paradoxical motion, particularly at sites adjacent to the spinal injury.

In summary, the 1967 study by Gdpson and colleagues offers critical insights into the effectiveness and limitations of various cervical orthoses. Their findings underscore the importance of selecting the right type of orthosis and ensuring a proper fit to maximize therapeutic effectiveness and minimize complications.


Overview and Efficacy of Cervicothoracic Orthoses

Cervicothoracic Orthoses are specialized devices designed to provide support and stabilization to both the cervical and thoracic regions of the spine. They typically consist of components that support the occiput (back of the head) and chin, connected to anterior and/or posterior plates that align with the thoracic area.

Improved Motion Control: Compared to cervical-only orthoses, cervicothoracic orthoses offer enhanced control over all planes of motion. This is due to their more extensive coverage and support that extends from the chin and occiput down to the thoracic spine.

Trade-off with Comfort: The increased rigidity and extensive coverage of cervicothoracic orthoses, while beneficial for motion control, often result in reduced patient comfort. This is an important consideration in patient compliance and overall satisfaction with the brace.

Evolution of Design: Early research distinguished between different designs of cervicothoracic orthoses, such as two/four poster designs and those with more extensive head-to-thoracic connections. However, modern classification systems now categorize all poster braces as cervicothoracic orthoses.

Efficacy of Traditional Designs: The traditional four-poster brace was notably effective, limiting up to 79% of overall cervical flexion-extension. It was also found to limit midcervical flexion comparably to more rigid cervicothoracic orthoses.

Current Usage Trends: Despite their effectiveness, the heavier design and high resting pressures exerted on the chin and occiput have led to a decline in the use of traditional four-poster braces in contemporary practice. They are less commonly used today, with preference often given to designs that balance efficacy with patient comfort.

In conclusion, cervicothoracic orthoses are vital in managing conditions requiring stabilization of the cervical and upper thoracic spine. While they offer improved control over motion, their design and comfort levels vary, influencing their current usage and patient acceptance.


Cervical Thoracic Orthosis

Cervical Thoracic Orthosis

The Sterno-occipital mandibular immobilizer utilizes metal uprights to connect occipital and mandibular rests to a sternal plate that is secured to the thorax by padded metal “over-the-shoulder” straps and additional circumferential straps that cross in the back.

  1. Indications
  2. Cervical spine surgery
  3. Whiplash injury
  4. Spinal cord injury of cervical
  5. Functions & Features
  6. Immobilize cervical spine and upper thoracic spine
  7. All straps are adjustable
  8. Forehead strap adds stabilization

Front and back supports for chin and occiput provide maximum control and suitable comfort


Cervico thoracic Orthoses

A: Frontal view. B: Posterior view. The padded U-shaped head band is attached to a large occipital flare which has a rigid connection to the posterior thoracic plate.

The thermoplastic body jacket has a lightweight, bivalved, Polyform shell that allows improved patient comfort and hygiene and interferes less with follow-up radiographs. Donning this brace is somewhat complex, often requiring an orthotist for proper application. More recently a prefabricated version of the body jacket has been developed, the Cervico thoracic Orthoses. Its design features a forehead band attached to a large occipital flare. Sharpe and colleagues demonstrated that this orthosis limits overall sagittal plane motion by 79%, axial rotation by 88%, and lateral bending by 51%.


Yale brace

A: Frontal view. B: Posterior view. Note the similarities of the head rest to a Philadelphia collar, from which the early version was originally adapted

The Yale brace was originally designed as a modified Philadelphia collar with custom molded anterior and posterior polypropylene thoracic extensions. The modern version is prefabricated. While lighter and less cumbersome than most of the other Cervico thoracic Orthoses, the Yale brace has similar efficacy in controlling motion. The Yale brace is reported to restrict 87% of overall flexion-extension, 75% of axial rotation, and 61% of lateral bending. While the Cervico thoracic Orthoses have been shown to be fairly effective at limiting motion of the cervical spine, they should not be expected to rigidly immobilize below the C7–T1 level despite their thoracic components. In the author’s experience, use of Cervico thoracic Orthoses in the bedbound patient is extremely problematic as the tendency for cephalad migration of the brace in the semirecumbent position increases the likelihood of pressure sore on the chin or occiput.