Child's Nervous System

, Volume 22, Issue 5, pp 460–465 | Cite as

Skin-covered midline spinal anomalies: a report of four rare cases with a discussion on their genesis and milestones in surgical management

  • A. Amirjamshidi
  • K. Abbassioun
  • M. Shirani Bidabadi
Brief Communication



The differential diagnosis for a dorsal midline mass presenting in a newborn encompasses a wide range of pathological conditions, including spinal dysraphisms, tumoral overgrowths including teratoma and hamartoma, disturbances in regression of fetal tail, and pseudotail formation.


To present (a) three rare cases of human tails and one case of tethered cord due to a midline anomaly resembling part of a human limb, (b) to discuss different kinds of clinical and pathological conditions which may be encountered in such newborns, (c) to hypothesize a theory about genesis of these congenital lesions, and (d) to remind drawbacks in preoperative evaluations and surgical management of these newborns.

Materials and methods

Four newborns with dorsal midline malformations initially diagnosed as heterotopias are presented. Appropriate preoperative investigations and proper surgical interventions leading to resection of the lesions were performed. All four were skin-covered lesions containing well-differentiated cellular elements of fat, vascular, muscular, bony, and cartilaginous origin. Midline spinal dysraphism was detectable both pre- and intraoperatively only in one case in which cord untethering was also performed along with the first surgical intervention. In the other three "tailed cases," midline bone defect could not be detected in the available X-ray films; consequently, simple excision of the tail-like lesions was done. The first patient had to be explored for repeat untethering of the cord after 4 years, but the others have not yet developed any sign of tethering during an average period of 12 years follow-up.


Morphological diagnosis of these lesions is not easy, and the attending pediatrician and neurosurgeon should be familiar with the differential diagnosis of such lesions and be prepared for possible time-consuming operation mandatory to achieve total resection of the lesion in a newborn under general anesthesia. Reviewing the possible theories regarding the genesis of such anomalies, it is hypothesized and suggested that all similar cases could have been of hamartomatous origin rather than defects of embryogenesis.


Hamartoma Heterotopia Lipomyelomeningocele Meningocele Myelomeningocele Teratoma Tethering 


  1. 1.
    Altman NR, Altman DH (1987) MR imaging of spinal dysraphysm. AJNR Am J Nuroradiol 8:533–538Google Scholar
  2. 2.
    Ames MD, Schut L (1972) Results of treatment of 171 consecutive myelomeningoceles. Pediatrics 50:466–470PubMedGoogle Scholar
  3. 3.
    Bar-Maor JA, Kesner KM, Kaftori JK (1980) Human tail. J Bone Joint Surg Br 62B:508–510Google Scholar
  4. 4.
    Belzberg AJ, Myles ST, Trevenen CL (1991) The human tail and spinal dysraphysm. J Pediatr Surg 26:1243–1245PubMedCrossRefGoogle Scholar
  5. 5.
    Brumfield CG, Aronin PA, Claud GA (1995) Fetal myelomeningocele. Is antenatal ultrasound useful in predicting neonatal outcome? J Reprod Med 40:26–30PubMedGoogle Scholar
  6. 6.
    Byrd SE, Darling CF, McLone DG (1991) Developmental disorders of the pediatric spine. Radiol Clin North Am 29:711–752PubMedGoogle Scholar
  7. 7.
    Carstens C, Mai G, Greiner C (1994) Malformations of the human tail bud or caudal agenesis syndrome. A review. Z Orthop Ihre Grenzgeb 132:345–356PubMedGoogle Scholar
  8. 8.
    Castillo M, Smith MM, Armao D (1999) Midline spinal cord hamartomas. MR imaging features of two patients. AJNR Am J Neuroradiol 20:1169–1171PubMedGoogle Scholar
  9. 9.
    Chakrabortty S, Oi S, Yoshida Y (1993) Myelomeningocele and thick filum terminale with tethered cord appearing as a human tail. A case report. J Neurosurg 78:966–969PubMedGoogle Scholar
  10. 10.
    Dao AH, Netsky MG (1984) Human tails and pseudotails. Hum Pathol 15:449–453PubMedCrossRefGoogle Scholar
  11. 11.
    Dubrow TJ, Wackym PA, Leasaroy MA (1988) Detailing the human tail. Ann Plast Surg 20:34–344CrossRefGoogle Scholar
  12. 12.
    Efrat Z, Perri T, Meizner I, Chen R, Ben-Rafael Z, Dekel A (2001) Early sonographic detection of a ‘human tail’. A case report. Ultrasound Obstet Gynecol 18:534–535PubMedCrossRefGoogle Scholar
  13. 13.
    Ente G, Penzer PH, Kenigsberg K, Sherman J (1991) The human tail. N Y State J Med 91:506–507PubMedGoogle Scholar
  14. 14.
    Fallon JF, Simandl BK (1978) Evidence of a role of cell death in the disappearance of the embryonic human tail. Am J Anat 52:398–399Google Scholar
  15. 15.
    Falzoni P (1995) The human tail. Report of a case. Minerva Pediatr 47:489–491PubMedGoogle Scholar
  16. 16.
    Galizia G (2001) True tail dorsal-lumbar: malformation or ancestral remaining? Minerva Pediatr 53:367–370PubMedGoogle Scholar
  17. 17.
    Gaskill SJ, Marlin AE (1988) Neuroectodermal appendages. The human tail explained. Pediatr Neurosci 15:95–98CrossRefGoogle Scholar
  18. 18.
    Gilbert GN, Jones KL, Rorke LB (1986) Central nervous system anomalies associated with meningomyelocele, hydrocephalus, and Arnold Chiari malformation; reappraisal of the theories regarding the pathogenesis regarding the pathogenesis of posterior neural tube closure defects. Neurosurgery 18:559–564PubMedCrossRefGoogle Scholar
  19. 19.
    Harrison RG (1901) On the occurrence of human tail in man, with a description of the case reported by Dr. Watson. Bull Johns Hopkins Hosp 12:96–101Google Scholar
  20. 20.
    Herman TE, Seigel MJ (1994) Special imaging case book. Neonatal sacrococcygeal teratoma. J Perinatol 14:492–494PubMedGoogle Scholar
  21. 21.
    James HE (1997) Spinal teratomas versus hamartomas. Pediatr Neurosurg 27:242–245CrossRefGoogle Scholar
  22. 22.
    Kabra NS, Srinivasan G, Udani RH (1999) True human tail. Indian Pediatr 36:712–713PubMedGoogle Scholar
  23. 23.
    Ledley FD (1980) Evolution and the human tail. A case report. N Engl J Med 306:1212–1215Google Scholar
  24. 24.
    Lemire RJ, Graham CB, Beckwih JB (1971) Skin covered sacrococcygeal masses in infants and children. J Pediatr 79:948–954PubMedCrossRefGoogle Scholar
  25. 25.
    Lue FL, Wang PJ, Teng RJ, Tsuo TY (1998) The human tail. Pediatr Neurol 19:230–233CrossRefGoogle Scholar
  26. 26.
    Lundberg GD, Parsons RW (1962) A case of human tail. Am J Dis Child 104:72–73PubMedGoogle Scholar
  27. 27.
    Matsuda H, Hata Y, Yano K (1991) Two cases of human tail. Jpn Pediatr Surg 23:1267–1274Google Scholar
  28. 28.
    Matsuo T, Koga H, Moriyama T, Yamashita H, Imazato K, Kondo M (1993) A case of true human tail with spinal lipoma. No Shinkei Geka 21:925–929PubMedGoogle Scholar
  29. 29.
    Matsumoto S, Yamamoto T, Okura K (1994) Human tail associated with lipomeningocele. Case report. Neurol Med Chir (Tokyo) 34:44–47CrossRefGoogle Scholar
  30. 30.
    McLone DG, Nadich TP (1985) Terminal myelocystocele. Neurosurgery 16:36–43PubMedCrossRefGoogle Scholar
  31. 31.
    Morris GF, Murphy K, Rorke L, James HE (1998) Spinal hamartomas: a distinct clinical entity. J Neurosurg 88:954–961PubMedGoogle Scholar
  32. 32.
    Odeku EL, Adeloye A (1970) A case of human pseudotail. West Afr Med J 19:115–116Google Scholar
  33. 33.
    Ohara Y (1980) Human tail and other abnormalities of the lumbosacral region relating to tethered cord syndrome. Ann Plast Surg 4:507–510CrossRefGoogle Scholar
  34. 34.
    Ohara K, Nakamura K (1994) Human tail. Br J Plast Surg 47:288–289PubMedCrossRefGoogle Scholar
  35. 35.
    Parsons RW (1960) Human tails. Plast Reconstr Surg 25:618–621CrossRefGoogle Scholar
  36. 36.
    Powell RW, Weber ED, Mani EA (1993) Intradural extension of a sacrococcygeal teratoma. J Pediatr Surg 28:770–772PubMedCrossRefGoogle Scholar
  37. 37.
    Rijsbosch JK (1977) Tail formation in man. Some historical notes on a case report. Arch Chir Neerl 29:261–268PubMedGoogle Scholar
  38. 38.
    Riley K, Palmer CA, Oser AB, Paramore CG (1999) Spinal cord hamartoma. A case report. Neurosurgery 44:1125–1127PubMedCrossRefGoogle Scholar
  39. 39.
    Sagehashi N (1992) An infant with Crouzon syndrome with a cartilaginous trachea and a human tail. J Craniomaxillofac Surg 20:21–23PubMedGoogle Scholar
  40. 40.
    Schropp KP, Lobe TE, Rao B (1992) Sacrococcygeal teratoma; the experience of four decades. J Pediatr Surg 27:1075–1079PubMedGoogle Scholar
  41. 41.
    Spiegelmann R, Schneider E, Mintz M, Blakstein A (1985) The human tail. A benign stigma, case report. J Neurosurg 63:461–462PubMedCrossRefGoogle Scholar
  42. 42.
    Talwalker VC (1982) Tale of a tail. N Engl J Med 307:1089Google Scholar
  43. 43.
    Tibbs PA, James HE, Rorke LB (1976) Midline hamartomas masquerading as meningomyeloceles or hamartomas in the newborn infant. J Pediatr 89:928–933PubMedCrossRefGoogle Scholar
  44. 44.
    White JJ, Wexler HR (1973) A baby with a tail. J Ped Surg 8:883CrossRefGoogle Scholar
  45. 45.
    Wright JD, Marder SJ, Geevarghese S, Shumway JB (2004) Prenatally diagnosed human caudal appendage. A case report. J Reprod Med 49:566–568PubMedGoogle Scholar
  46. 46.
    Yamatani K, Saitoh T, Oi M, Endoh T, Takaka A (1991) A case of human tail. No Shinkai Geka 19:93–96Google Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • A. Amirjamshidi
    • 1
  • K. Abbassioun
    • 2
  • M. Shirani Bidabadi
    • 1
  1. 1.Sina HospitalTehran University of Medical SciencesTehranIran
  2. 2.Dr. Shariati HospitalTehran University of Medical SciencesTehranIran

Personalised recommendations