HUMAN

J. A. BAR-MAOR, K. M.

TAILS
KESNER, J. K. KAFTORI

From

the

Department

of Paediatric Rambam

Surgery University

and

the

Department Haifa

of Diagnostic

Radiology,

Hospital,

Two medical together

children curiosity with the

and is briefly tail

one may

infant

with

a human

tall is usually

are

presented.

The

patbo-embryologjr

discussed.
become

Treatment

indicated

unnecessary but resection by coccygodynia or for aesthetic

ofpart
reasons.

ofthe

of this coccyx

A literature

human describe

tail

is

ill-defined. projections

Reports in the

in

the cocCase noticed particularly

continent operation of or

CASE 1 . A 10-year-old complaining some years severe both urine Arab ofpain when in 1977 in the

REPORTS at our had There those to there posterior movement, lower vertebral Outpatient This become was no worse history Department had first and been was coccygeal but faeces. than seen region.

soft-tissue

boy arrived

cygeal region (Parsons 1960; Lundberg and Parsons 1962; F#{225}ra and Smahel 1973): these probably represent a persistence of the embryonic tail, the non-chondrified lower coccygeal segments (Parsons 1960). Reports of

previously and other he was examination On inspection, the passive discomfort. of the coccyx and great

he was sitting

on hard

surfaces.

He was fully of injury, occurring well-developed there was no to be the tip, the but abnormality found of in

illnesses

commonly

such cases in the last century

Bartels caudal tail, (1 883) appendages tail the fourth who described in man: presumably is a bony

led to the five types three arising of these from fifth young

classification of rudimentary are the variations embryonic

by

childhood. On child. but

caused

examination, Systematic deficit. flexible the patient and of lateral number

be a healthy, normal bony and wall particularly was no perineal

was

neurological on rectal markedly A normal there and

of a soft

examination

was

tail caused

by hypertrophy is a true children

of the animal with

sacrococcygeal vertebrae and the tail containing additional vertebrae. In the past three years three tails have been seen.

radiograph prominent five

column

showed vertebrae

configuration well-developed

of lumbar measuring

and sacral

was a very consisting

8.5 centimetres vertebrae.

in length

Anteroposterior

Case soft

2. Figure 1 - tissue. Figure

Human 2-Lateral

tail

formed radiograph
coccygeal

well-developed

of coccygeal vertebrae of the sacrum and vertebrae.

and three

J. A. Bar-Maor, K. M. Kesner, J. K. Kaftori, Requests for

MD, FACS, Chief, Department of Paediatric Surgery MB, ChB, Junior Registrar, Department of Paediatric Surgery MD, Director of Ultrasound Unit, Department of Diagnostic Radiology reprints should be sent to Dr J. A. Bar-Maor.

1
?.

Rambam Technion,

University Faculty

Hospital,

of

Medicine,

Haifa,

Israel.

508

THE

JOURNAL

OF BONE

AND

JOINT

SURGERY

HUMAN radiographs segment coccygeal Partial because enough Case

referred

TAILS

509
:

of but

the

pelvis were of the operation. later,

showed normal again coccyx that

a spina sacral was the in evidence.

bifida

of

the The

first

sacral

an otherwise excision

configuration. considered symptoms but

prominent performed not severe was the a soft of the coccygeal on and the after

vertebrae the parents years

our

not

believed in 1979,

were Jewish
of a

to warrant 2. Two
to

a three-month-old
because

baby above

Outpatient

Department

tail

,&

anus. lower

On examination vertebral (Fig. aesthetic together was One she month with has no 2). For

there column reasons with later, the same pain without

were region showed the part

no pathological (Fig. three infant of the

findings

except

protrusion vertebrae protrusion operation Case 3). under

3.

in the coccygeal

1). A lateral

radiograph

well-developed was operated excised. came

coccyx girl cosmetic intervention,

Progress

t:

uneventful. a six-year-old anatomical nor any surgical to our Outpatient (Fig. remains being. she the time and radiographic complaint for findings

Department Since

cj.IT;::

observation,

DISCUSSION Development of the day

coccyx

Somite
twenty-first

formation

begins
(Williams,

in the embryo Wendell-Smith

soon and

after the Tread-

gold 1966). Reiter (1944) found that the greatest number of somites were seen at an embryonal length of seven millimetres (the fifth week) when he noted a total of 42: lumbar, meoderm five occipital, five sacral extends seven cervical, 12 and eight coccygeal. medially to envelop mesenchymal (Williams coccygeal thoracic, five The somitic the notochord known Reiter into

I;

and form the primitive as blastemal vertebrae found blastemal that all eight vertebrae.

vertebrae et al. 1966). developed

segments

.. . .
Case 3. Lateral radiograph developed Fig. 3 of the sacrum coccygeal vertebrae. and three well-

Centres of chondrification vertebrae about the sixth week, ates and the vertebral column supporting structure (Williamsetal. tion centres do not appear blastemal coccygeal

appear in the the notochord takes

iii

blastemal degener-

over as the axial 1966). Chondrificathe lowest coccygeal

The

development

of

the

coccygeal

tail

in our

vertebrae. As cartilage develops in the upper region, the lowest segments disappear. By the when the is almost embryo that measures 30 millimetres, of the adult: the eighth, disappeared of reduction processes

eighth week, the anatomy seventh and the involving (Reiter Each centres: in the

patients can be explained as follows. Somite was normal and all eight coccygeal segments blastemal vertebrae. The eighth, seventh segments coccygeal chondrification in the second occurred centres, present On first and disappeared vertebrae as normal. developed

formation developed and sixth of

and sixth fifth and the 1944). loss

coccygeal fourth of

segments have are in a process vertebral

Each of the remaining primary centres (Parsons 1960):

as in typical patient there third patients

vertebrae

recognisable

were five vertebrae, in the there were three. Ossification three were primary already

typical vertebra is ossified from three primary one in each half of the vertebral arches and one body. Each segment of the coccyx, however, is one primary cenlre (Grays Anatomy for the first segment appears about segments ossify at widely separated year or later, but The normal coccyx and usually consisting fused together; to five or reduced the is a of

as in typical vertebrae from and it is likely that these centres by the third month in utero.

ossified from only 1967). The centre birth. The remaining intervals specific small up times bone,

human

tails
coccygeal protuberwas well evident on and was the cause of could be described in as a bony tail caused
.

to the twentieth are not known. triangular in shape vertebrae increased 1967).
1980

Our first patient had no obvious ance, but the coccygeal anomaly radiographs as a tail-like structure his coccygodynia. This anomaly Bartels traditional classification by hypertrophy second and

four rudimentary number may be (Grays

VOL. 62-B,

but the to three

Anatomy
No.

of the sacrococcygeal vertebrae third patients had almost similar

Our

radio-

4, NOVEMBER

510

J.

A.

BAR-MAOR,

K.

M.

KESNER,

J.

K.

KAFTORI

graphic
tuberances. Miller who had the skin

findings,

but

in

addition the case

they

had

soft

proofficer under

Although problem, inconvenience excision patient,

our they of may

first

and

third

patients

may

never

have

this

(1 88 1) reported an elongated and caused him coccyx great

of an Army made a bulge in riding

will be followed of the tail become coccyx, as be considered.

up, and should the intolerable, partial in our second

which difficulty

the

performed

a horse.
REFERENCES

Bartels Fira Grays Lundberg Miller M,

M.

Die

geschwanzten

Menschen. tail. London:

A

Arch Chir Plast

Antropo/ (Praha) 1967:286-90. tail. Am

1883;15:45-131.

Smahel Anatomy.
GD,

J.

Human ed.
RW.

Acta case

1973;15:184-9. I Dix Chi/d 1962;104:72-3.

34th

Longmans, of a human Surg Reconstr Rep 1881 Surg

Parsons
Human

CH. RW.

Tailed Die
PL,

humanity. tails.

Med P/ast
CP,

;45:165-6. 1960;25:618-21. Wirbels#{228}ule. Z Anat Entwick London: 1944;113:203-27. Pitman Medical Publishing Company, 1966:53,82-3. human embryo/ogy.

Parsons
Reiter Williams A.

Fruhentwicklung Wendell-Smith

der

menschlichen

Treadgold

S. Basic

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