Surgical Treatment of a Patient with Human Tail and Multiple Abnormalities of the Spinal Cord and Column

Abstract

The dorsal cutaneous appendage, or so-called human tail, is often considered to be a cutaneous marker of underlying occult dysraphism. The authors present a case of human tail occurring in a 9-month-old infant with multiple abnormalities of the spinal cord and spine. Examination revealed unremarkable except for a caudal appendage and a dark pigmentation area in the low back. Neuroradiological scans revealed cleft vertebrae and bifid ribbon, split cord malformations, block vertebrae, and hemivertebra. Surgical excision of the tail and untethering the spinal cord by removal of the septum were performed. The infant had an uneventful postoperative period and was unchanged neurologically for 18 months of followup. To our knowledge, no similar case reports exist in the literature. The specific features in a rare case with a human tail treated surgically are discussed in light of the available literature.

An infant with caudal appendage

“…Chunquan Cai et al have reported a case of human tail coexisting with type I split cord malformations 6. Donovan et al have reported child with a tail and intraspinal lipoma that were not contiguous with each other, and were separated by an intact layer of lumbosacral fascia, in our case also there were no subfascial extension of the tail structure 7…”

A True Tale of a False Tail: A rare case of Vestigial Tail with Spina Bifida

“…Spinal sonography can be used in early infancy [1]; MRI provides much larger field of view and is required prior to an intervention, if spinal sonogram demonstrates spinal abnormality requiring surgery. [1] True tail requires simple surgical excision [2] in contrast with pseudotail which also require surgical repair of underlying spinal abnormality which was done in our case. Long term follow up is required for neurological assessment.…”

A True Human Tail in a Neonate: Case report and literature review

“…2 Early untethering of the cord is essential to prevent the development of catastrophic neurological sequelae. 9,14,21 The incidence of cutaneous lesions along the craniospinal axis in the general population is approximately 3% and the most common lesions are deep dimples. 22 However, cutaneous signs are present in 76% of patients with occult spinal dysraphism, including tails, dermal sinuses, lumbar lipomas, port wine stains, deviated gluteal furrows, hypertrichosis, haemangiomas and hamartomas.…”

“…2,[5][6][7][8][9] The proximal portion of the tail bud has 10-12 vertebrae, whereas the distal portion is composed of mesodermal elements without vertebrae. During the seventh and eighth gestational weeks, the proximal mesodermal elements retract into the soft tissue and the distal mesodermal ions are rare.…”

“…2,[5][6][7][8][9] According to Lu et al, the presence of a human tail is an abnormality in embryonic development, rather than a regression in the evolutionary process. 2 In mice and other vertebrates, the genes that control the development of tails are the Wnt family member 3A (WNT3A) and caudal type homeobox 1 genes; the downregulation of the WNT3A gene has been observed to induce apoptosis of the tail cells in mice.…”