Professional Documents
Culture Documents
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,
one may
infant
with
a human
tall is usually
are
presented.
The
patbo-embryologjr
discussed.
become
Treatment
indicated
ofpart
reasons.
ofthe
of this coccyx
A literature
human describe
tail
is
ill-defined. projections
Reports in the
in
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
led to the five types three arising of these from fifth young
by
was
of a soft
examination
was
tail caused
sacrococcygeal vertebrae and the tail containing additional vertebrae. In the past three years three tails have been seen.
column
showed vertebrae
configuration well-developed
of lumbar measuring
and sacral
in length
Anteroposterior
Case soft
Human 2-Lateral
tail
formed radiograph
coccygeal
well-developed
and three
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
TAILS
509
:
of but
the
bifida
of
the The
first
sacral
an otherwise excision
prominent performed not severe was the a soft of the coccygeal on and the after
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
findings
except
in the coccygeal
1). A lateral
radiograph
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,
coccyx
Somite
twenty-first
formation
begins
(Williams,
soon and
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.
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
blastemal degener-
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
coccygeal fourth of
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
Anatomy
No.
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
they
had
soft
proofficer under
first
and
third
patients
may
never
have
this
which difficulty
the
performed
a horse.
REFERENCES
M.
Die
geschwanzten
1883;15:45-131.
Smahel Anatomy.
GD,
J.
Human ed.
RW.
Acta case
34th
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
THE
JOURNAL
OF BONE
AND
JOINT
5URGERY