![]() ![]() The continued uneven growth causes the tail bud to extend and curl beneath the hind gut. The somites are formed, and the remaining primitive knot and streak compose a compact mass at the caudal end of the embryo that is called the tail bud or end bud. The associated embryogenesis of the human tail is first noted at the fourth week of gestation. However, their classification is mainly based on histolopathological findings and is not done from an embryological standpoint. A pseudotail is a caudal protrusion composed of other normal and abnormal tissue. The true human tail lacks vertebrae in all cases and is usually attached to the skin of the sacrococcygeal region. A true human tail is defined as a boneless, midline protrusion capable of spontaneousor reflex motion. They distinguished true or persistent vestigial tails from other forms of caudal appendages or pseudotails. The present case demonstrates a cutaneous marker in the form of a tail at the back tip of coccyx coexisting with split cord malformations.ĭao and Netsky reviewed 32 previous descriptions of tails published from 1859 to 1982. But no report similar to our patient exists in the literature. As a consequence, a multitude of spinal cord and spine anomalies associations including spina bifida, meningocele, lipomeningoceles, myelomeningocele, intraspinal lipoma, spinal cord tethering, coccygeal vertebrae have been described in patients with human tail. There have been many previous reports to date that spinal dysraphism is usually accompanied by several anomalies, including skin protrusion, pigmentation, sinus formation, human tail, and subcutaneous or spinal lipomas. However, certain authors have considered these to be a benign stigma without any cord malformations. The dorsal cutaneous appendage, or so-called human tail, is considered to be a marker of underlying intraspinal pathology of occult spinal dysraphism. His bowel and bladder habits were also normal. ![]() In the followup till 18 months, he was all right without any neurological deficit. The infant was recovered uneventfully in the postoperative period. The other abnormalities of the spine were untreated. The filum terminale was thickened and was transected. The spinal cord was untethered and decompressed by removal of the septum. Two hemicords were shown to course within two separate dural sleeves ( Figure 3). A bony septum originating from segmented lumbar vertebrae was found to divide the spinal cord. The lumbar fascia was opened and L 4–L 5 laminoplasty performed. Despite careful inspection for a fascial defect and subfascial extension of the tail structure, none was observed, and the tail was removed enbloc. The tail was elliptically excised, and the subcutaneous portion sharply dissected from the dorsal lumbosacral fascia. With the impression of human tail coexisting with type I split cord malformations, operation of resection of the tail, removing of the septum and spinal cord untethered, was done with continuous intraoperative monitoring of sensory evoked potentials and electromyogram recording of lower extremity and sphincter muscles. Magnetic resonance imaging (MRI) showed split cord malformations ( Figure 2(d) and 2(e)). Computed tomography (CT) scans showed split cord malformations, block vertebrae of the third and fourth vertebrae, and hemivertebra of the second sacral vertebrae (Figures 2(b) and 2(c)). Plain radiographs revealed cleft vertebrae of the ninth thoracic vertebrae, and bifid rib of the fourth rib ( Figure 2(a)). He did not have any family history of congenital abnormality. There was no history of any illness, exposure to radiation, or taking any drug during pregnancy. The infant was born after an uneventful pregnancy. There was normal rectal tone with an anal wink reflex present bilaterally. His muscle strength, tone, and sensation were intact with normal reflexes present. No bony attachment or any voluntary movement was observed in the mass. It was soft and nontender, covered with normal skin. ![]() According to the parents, the tail was about 2 cm at birth and the size had been increasing with age. A dark pigmentation area in the low back was also found ( Figure 1). On physical examination, the appendage was 5 cm long and was attached to the back tip of coccyx appearing like a human tail ( Figure 1). A 9-month-old healthy male infant was brought for consultation for a “tail like” structure in the lumbosacral area since birth. ![]()
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