Cervical Thoracic Orthosis

Your consultant has advised that you should wear a CTO

What is a cervical thoracic orthosis (CTO)?

A CTO is a cervical collar (neck brace) that has an extension support to also protect the thoracic spine. It limits movement whilst providing you with support and can also provide some pain relief. The CTO will be decided by your team. We mainly use Aspen Vista CTOs at The Walton Centre however other types are available and may be required depending upon your individual needs. Your spinal nurse practitioner should clarify this with you prior to your discharge.

The CTO is a two-piece semi rigid neck brace, held together by Velcro straps. The brace support is provided by plastic on the outside and soft pads to the inside. It then has an extension across the chest and two buckles which fasten at your waist.

Why do I need it?

CTOs are required for multiple reasons; the most common being for fracture management in the neck or upper thoracic spine (broken bone) and the CTO is used for management of the fracture. It can also be used for support pre/post-surgery.

The CTO will encourage correct spinal alignment and aim to prevent the development of potential further problems. It may be necessary to apply pads to help prevent pressure damage for any patients deemed ‘at risk’. This will be continually reviewed whilst you are in the appliance. If such padding is required you will be informed and this padding can also be washed and reapplied.

How does it work?

The CTO works by reducing the ability to move your neck and upper back. This reduces the movement of bone to promote and aid healing. The CTO will only limit movement in the neck and upper back; it will not completely eliminate it so it is important it fits correctly.

The CTO will help your neck and upper back support the weight of your head while the bone, the soft tissues and muscles in your neck heal. Following cervical or thoracic spine (neck/upper back) surgery or sustaining a fracture the CTO will help keep your neck bones in line while you heal.

How long will I need it for?

The reason why you require the CTO will determine the length of time you require it for. Your consultants will make this decision.

How should the CTO fit?

It is important you are completely comfortable with your CTO prior to discharge. Please ensure you ask to see one of the Spinal Nurse Specialists or experienced health care professionals should you require more support or advice.

You will be measured and fitted with an appropriately sized and shaped CTO. The front piece of the CTO will sit under your chin and upon your chest; the back panel will sit at the base of your skull and extend to your shoulders. The two pieces are held together by Velcro and together completely encase and cover your neck. It is important to wear your cervical collar aspect of the CTO properly to get the maximum benefit.

The cervical collar aspect should be tight enough to prevent movement of your neck, for example restrict ‘yes’ and ‘no’ movements however not completely restrictive so that it affects you’re breathing or swallowing.

Please seek medical advice if:

• The CTO becomes damaged.
• The skin under the CTO has broken down.
• You have run out of replacement pads.
• The CTO now has become poorly fitted.
• Develop and new numbness or weakness in the arms or legs.
• Any new difficulty with swallowing/ or new choking episodes.
• Any new disturbed vision.

Changing the CTO

You should remove the CTO once a day to ensure your skin is clean, dry and there are no areas of irritation. You will be provided with a spare set of pads. Unless you have been told otherwise by your consultant you should wear the CTO in the shower and change to dry pad inserts once you have finished showering. It is important to refrain from unnecessary movement of your neck and upper spine during this process.

Posterior (BACK) of the CTO:

• Back of cervical collar
• Back of waist strap

Anterior (FRONT) of the CTO:

Front of the cervical collar with front of thoracic extension and front of waist straps all attached as one piece.

Whilst lying down

• To apply the CTO, have a family member, carer or mirror to hand to look at your neck and upper back to ensure there is no irritation or areas for concern.
• Ensure your neck and upper back are completely dry.
• Apply the CTO by firstly applying the posterior (back) portion foam facing your skin under your neck and back flush to the mattress, centre yourself as much as possible.
• Ensure your shoulders, neck and head are completely supported by the bed.
• Front panel should be slid up from the chest wall and placed under the chin ensuring this is central.
• Attach the straps one side at a time, ensuring the chin is sat on top of the chin rest.
• Then attach the waist straps ensuring you hear the ‘click’ which means it is secured.
• Once upright you can ensure the fit is correct. Whilst holding the front panel, tighten straps as much as can be safely tolerated.
• Any hair should be placed over the back of the collar.
• When removing the CTO first unclip the waist straps/buckles (both sides)
• Then the cervical collar aspect of the CTO by releasing one of the Velcro straps, pull the front panel of the collar away from your neck and slowly slide out the back panel from one side of your neck.

Whilst sitting

• To apply the CTO. Have a family member, carer or mirror to hand to look at your neck and ensure there is no irritation or areas for concern. 
• Ensure your neck and upper back are completely dry.
• Ensure your shoulders, neck and head are completely supported by the chair.
• Keep head and neck in a neutral position (nose in line with belly button) were possible.
• Do not bend forwards, backwards or side to side where possible.
• Place the back panel behind the neck, make sure it is centred.
• Apply the front aspect of the CTO and attach the collars Velcro straps one side at a time to fit to the front panel, ensuring the chin is sat on top of the chin rest.
• Whilst holding the front panel, tighten straps as much as can be safely tolerated.
• Ensure the back part of the CTO is secured by applying the waist buckles.
• Then attach the waist straps ensuring you hear the ‘click’ which means it is secured.
• Remove the CTO firstly by unclicking the waist straps / buckles (both sides).
• Then release one of the Velcro straps from the collar part of the brace, you can then pull the front panel of the collar away from your neck and slowly slide out the back panel from one side of your neck.

Cleaning the CTO

• Both foam to front and back panels detach. 
• Peel the foam off, paying close attention to the shape as you remove them so you can reposition correctly. 
• Wash with mild soap and water.
• Do not use bleach products or detergent on the foam.
• Squeeze any excess water out of the foam padding.
• Lay the foam pads flat to dry.
• The plastic shell of the collar and waist will need to be wiped, the reattach padding.

Key points to remember

• Unless you have been informed otherwise you should wear this CTO while showering and be provided with a spare foam to change into following the shower. 
• You should change the CTO while lying down or if upright with your head/neck and shoulders fully supported.
• Your chin should not sit inside or stick out over the collar, but flush with the collar edge.
• The CTO should rest comfortably against your body, with only the padded areas touching your skin. 
• The CTO should be facing the correct way to give you the required support (as pictured above).
• Hair should be placed on the outside of the collar.
• Ensure no earrings or jewellery cause pressure to your skin when the collar is in use.
• You should keep your neck clean and dry.
• Your CTO should be removed daily for cleaning of your neck, on dong this you should check to make sure there are no areas of skin irritation/pressure damage underneath the CTO.
• Please see page 3 for instructions on appliance application.
• The pads and plastic of the CTO can be cleaned with mild soap and water.
• Driving a vehicle is not permitted whilst in the CTO. You will need to discuss returning to driving with the DVLA.
• Wearing the CTO will likely cause weakness to the muscles supporting your neck, as the CTO has been doing this work, when you no longer require the CTO, we would advise this is gradually removed over 1 -2 weeks.
• You may be provided with a homebased exercise programme by the physiotherapists. This should be completed when your Consultant says it is safe to do so. The homebased physiotherapy exercise programme (leaflet will be provided, when safe to do so) will restore the movement to your neck muscles.

Please contact the spinal nurse specialists for any advice or support required while you require a cervical spine collar.

Spinal nurse practitioners are available Monday to Friday between the hours of 9am to 5.30pm.

Please note this is an answer machine facility: Tel:- 0151 556 3424

The Physiotherapy department can also be contacted 8am- 4pm Tel: 0151 556 3863

Out of the stated hours please contact the ward you were admitted to on the telephone number you were provided on discharge.