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Analysis of skull bone thickness during growth: an anatomical guide for safe pin placement in halo fixation

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A Correction to this article was published on 13 May 2020

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Abstract

Purpose

To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age.

Methods

270 children and adolescents (age: 0–17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL).

Results

From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P < 0.01). At the end of growth, the thickest and thinnest points of the vault (absolute value) were found at the P and L measurement sites, respectively (P < 0.01). Children aged < 4 years exhibited the highest variability in AL and PL skull bone thickness, with thickness < 3 mm observed in 85% (64/75 patients) and 92% (69/75 patients) of cases, respectively.

Conclusion

We recommend that the tip of the pin should not exceed 2–3 mm in children aged < 4, and 4 mm in children aged 4–6 years, to decrease the risk of inner table perforation. After the age of 7 years and 13 years, standard-sized pin tips (5 and 6 mm, respectively) may be safely used. Children aged < 4 years show significant variability in skull thickness, and therefore a CT scan may be required for this particular age group.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Hospital Universitario y Politécnico La Fe, Doctorate School, Universidad católica de Valencia san vicente martir, Av. Fernando Abril Martorell, nº 106, 46026, Valencia, C. Valenciana, España

    P. Domenech-Fernandez

  2. Department of Orthopaedic Surgery, National Hospital Organization Murayama Medical Center, Keio University, Tokyo, Japan

    J. Yamane

  3. Department of Orthopaedic Surgery. Hospital Arnau de Vilanova, Universidad CEU-Cardenal Herrera, Valencia, Spain

    J. Domenech

  4. School of Doctorate, Universidad Católica de Valencia San Vicente Martir, Valencia, Spain

    P. Domenech-Fernandez & C. Barrios

  5. Department of Pediatric Orthopedic Surgery, Hospital Universitario Valle de Hebron, Barcelona, Spain

    F. Soldado-Carrera & J. Knorr

  6. Department of Pediatric Orthopedic Surgery, University Hospital Estaing, Clermont Ferrand, France

    F. Canavese

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  1. P. Domenech-Fernandez
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  2. J. Yamane
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  3. J. Domenech
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  4. C. Barrios
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  5. F. Soldado-Carrera
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  6. J. Knorr
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  7. F. Canavese
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Correspondence to P. Domenech-Fernandez.

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Domenech-Fernandez, P., Yamane, J., Domenech, J. et al. Analysis of skull bone thickness during growth: an anatomical guide for safe pin placement in halo fixation. Eur Spine J 30, 410–415 (2021). https://doi.org/10.1007/s00586-020-06367-x

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  • DOI: https://doi.org/10.1007/s00586-020-06367-x

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