Sternal-Occipital-Mandibular Immobilizer (SOMI)
Cervico-Thoracic Orthoses (CTOs) provide greater motion restriction from C5-C7 spine from the increased leverage on the person’s body. The upper cervical spine has less motion restriction. CTOs are used in minimally unstable fractures. All CTO’s tend to control flexion better than extension.
The SOMI is a rigid, 3-poster CTO that has an anterior chest plate extending to the xiphoid process, as well as metal or plastic bars that curve over the shoulder. Straps from the metal bars go over the shoulder and cross to the opposite side of the anterior plate for fixation. A removable chin piece attaches to the chest plate with an optional headpiece that can be used when the chin piece is removed for eating. The 2-poster CTOs start from the chest plate and attach to the occipital component. The SOMI is ideal for bedridden patients because it has no posterior rods.
The SOMI is relatively comfortable to wear. Proper adjustment is crucial for motion restriction, which may be minimal if the orthosis is correctly applied. The SOMI controls extension less effectively than the other braces do, but it very effectively controls flexion at the atlantoaxial and C2-C3 segments. The SOMI controls flexion in the C1-C3 segments better than any other CT0 brace.
Motion Restrictions:
• Cervical flexion and extension are limited by 70%-75%
• Lateral bending is limited by 35%
• Rotation is limited by 60-65%
• Cervical flexion and extension are limited by 70%-75%
• Lateral bending is limited by 35%
• Rotation is limited by 60-65%
Indications:
• Atlantoaxial instability caused by rheumatoid arthritis (Note that ligamentous disruption in rheumatoid arthritis affects flexion more than extension, because extension is held in check by the intact dens.)
• Neural arch fractures of C2, because flexion causes instability
• Atlantoaxial instability caused by rheumatoid arthritis (Note that ligamentous disruption in rheumatoid arthritis affects flexion more than extension, because extension is held in check by the intact dens.)
• Neural arch fractures of C2, because flexion causes instability
Contraindications:
The SOMI controls extension less effectively than do other orthoses.
Flexion and extension control at C3-T1: better served with a Minerva
The SOMI controls extension less effectively than do other orthoses.
Flexion and extension control at C3-T1: better served with a Minerva
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