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Human tail with noncontiguous intraspinal lipoma and spinal cord tethering: case report and embryologic discussion
Daniel J Donovan1, Robert C Pedersen
1Neurosurgery Service, Department of Surgery, Tripler Army Medical Center, Honolulu, Hawaii, USA. daniel. donovan@amedd.army.mil
Insights
A rare congenital tail in children, often linked to spinal issues, can be successfully treated. Surgical removal of the tail and intraspinal lipoma resolved tethered cord syndrome, leading to normal neurological development.
Area of Science:
- Pediatric Surgery
- Developmental Biology
- Neurology
Background:
- Congenital tails are rare malformations associated with spinal cord abnormalities.
- Tethered cord syndrome, often caused by contiguous fibrolipomas, is a common complication.
Observation:
- A case of a child with a non-contiguous tail and intraspinal lipoma separated by fascia is presented.
- The tail and lipoma were surgically removed, and the spinal cord untethered.
Findings:
- The child remained neurologically normal two years post-surgery.
- The non-contiguous nature of the lipoma suggests alternative etiologies beyond typical secondary neurulation defects.
Implications:
- This case broadens the understanding of congenital tail and spinal lipoma formation.
- It highlights the importance of considering secondary neurulation and embryonic tail bud regression disorders in etiology.
Abstract:
Children born with a tail-like appendage have a rare malformation that is frequently associated with abnormalities of the spine and spinal cord. A contiguous fibrolipoma is usually seen extending from the subcutaneous portion of the tail into the inferior spinal cord, resulting in tethered cord syndrome. We present the case of a child born with a tail and intraspinal lipoma that were not contiguous with each other, and were separated by an intact layer of lumbosacral fascia. The tail and lipoma were removed and the spinal cord untethered, and the child is neurologically normal 2 years after surgery. The absence of a contiguous lipoma from the tail to the spinal cord suggests that this condition may be principally caused by a disorder of secondary neurulation and/or regression of the normal embryonic tail bud. The embryology of the lower spine is reviewed and possible etiologies discussed.
