Predictive factors for degenerative lumbar spinal stenosis: a model obtained from a machine learning algorithm technique.

BACKGROUND: Degenerative lumbar spinal stenosis (DLSS) is the most common spine disease in the elderly population. It is usually associated with lumbar spine joints/or ligaments degeneration. Machine learning technique is an exclusive method for handling big data analysis; however, the development of this method for spine pathology is rare. This study aims to detect the essential variables that predict the development of symptomatic DLSS using the random forest of machine learning (ML) algorithms technique. METHODS: A retrospective study with two groups of individuals. The first included 165 with symptomatic DLSS (sex ratio 80 M/85F), and the second included 180 individuals from the general population (sex ratio: 90 M/90F) without lumbar spinal stenosis symptoms. Lumbar spine measurements such as vertebral or spinal canal diameters from L1 to S1 were conducted on computerized tomography (CT) images. Demographic and health data of all the participants (e.g., body mass index and diabetes mellitus) were also recorded. RESULTS: The decision tree model of ML demonstrate that the anteroposterior diameter of the bony canal at L5 (males) and L4 (females) levels have the greatest stimulus for symptomatic DLSS (scores of 1 and 0.938). In addition, combination of these variables with other lumbar spine features is mandatory for developing the DLSS. CONCLUSIONS: Our results indicate that combination of lumbar spine characteristics such as bony canal and vertebral body dimensions rather than the presence of a sole variable is highly associated with symptomatic DLSS onset.

Has the COVID-19 outbreak altered the prevalence of low back pain among physiotherapy students?

OBJECTIVE: To evaluate the prevalence of low back pain (LBP) among physiotherapy students during the COVID-19 lockdown in the State of Israel. PARTICIPANTS/METHODS: One hundred and sixty four physiotherapy students from all four-year student levels were invited to participate. One hundred and thirty-seven students (83.5%) were recruited in the study with 79 females (57.7%) and 58 males (42.3%). We used a structured anonymous questionnaire that sought standard information on age, height, weight, sports activity and low back pain (LBP) prevalence during three periods. RESULTS: No significant differences were noted in the prevalence of LBP between the lockdown period compared to 12-month period in all four-year levels. More so, our findings showed that LBP prevalence among physiotherapy students was greater during the 12-month period compared to the lifetime period. CONCLUSIONS: This study indicates that COVID-19 lockdown has no negative impact on the prevalence of LBP among physiotherapy students.

The Role of Vertebral Morphometry in the Pathogenesis of Degenerative Lumbar Spinal Stenosis.

The aim of the current study was to establish whether the vertebral morphometry (e.g., vertebral body width and spinal canal diameters) is associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study from L1 to L5 for two sample populations was used. The first included 165 participants with symptomatic DLSS (sex ratio 80 M/85F), and the second had 180 individuals from the general population (sex ratio: 90 M/90F). Vertebral body length (VL) and width (VW) were significantly greater in the stenosis males and females compared to their counterparts in the control. The mean VL in the stenosis males was 31.3 mm at L1, 32.6 mm at L2, 34 mm at L3, 34.1 mm at L4, and 34.5 at L5 compared to 29.9 mm, 31.3 mm, 32.6 mm, 32.8 mm, and 32.9, respectively, in the control group (P ≤ 0.003). Additionally, the bony anterior-posterior (AP) canal diameters and cross-sectional area (CSA) were significantly smaller in the stenosis group compared to the control. The mean AP canal values in the stenosis males were 17.8 mm at L1, 16.6 mm at L2, 15.4 mm at L3, 15.6 mm at L4, and 16.1 at L5 compared to 18.7, 17.8, 16.9, 17.6, and 18.8, respectively, in the control group. Vertebral length (OR-1.273 to 1.473; P ≤ 0.002), AP canal diameter (OR-0.474 to 0.664; P ≤ 0.007), and laminar inclination (OR-0.901 to 0.856; P ≤ 0.025) were significantly associated with DLSS. Our study revealed that vertebral morphometry has a role in DLSS development.

3D virtual reconstruction and quantitative assessment of the human intervertebral disc's annulus fibrosus: a DTI tractography study.

The intervertebral disc's (IVD) annulus fibrosus (AF) retains the hydrostatic pressure of the nucleus pulposus (NP), controls the range of motion, and maintains the integrity of the motion segment. The microstructure of the AF is not yet fully understood and quantitative characterization is lacking, leaving a caveat in modern medicine's ability to prevent and treat disc failure (e.g., disc herniation). In this study, we show a reconstruction of the 3D microstructure of the fibers that constitute the AF via MRI diffusion tensor imaging (DTI) followed by fiber tracking. A quantitative analysis presents an anisotropic structure with significant architectural differences among the annuli along the width of the fibrous belt. These findings indicate that the outer annuli's construction reinforces the IVD while providing a sufficient degree of motion. Our findings also suggest an increased role of the outer annuli in IVD nourishment.

Spinous Process Inclination in Degenerative Lumbar Spinal Stenosis Individuals.

The aim of this study is to determine the sagittal inclination of lumbar spinous processes (SPs) in individuals with degenerative lumbar spinal stenosis (DLSS). It is a retrospective computerized tomography (CT) study including 345 individuals divided into two groups: control (90 males, 90 females) and stenosis (80 males and 85 females. The SP inclination was measured in the midsagittal plane from L1 to L5 levels. Stenosis males (L3-L5) and females (L1, L4) manifested significantly greater SP inclination compared to their counterparts in the control group. Males had significantly horizontal SP orientation compared to females (L1, L2). We also found that SP inclination became steeper as we descend caudally. This study indicates that SP inclinations are significantly associated with DLSS.

Facet Tropism and Orientation: Risk Factors for Degenerative Lumbar Spinal Stenosis.

The aim of this study is to establish whether facet tropism (FT) and orientation (FO) are associated with degenerative lumbar spinal stenosis (DLSS). A retrospective computerized tomography (CT) study including 274 individuals was divided into two groups: control (82 males and 81 females) and stenosis (59 males and 52 females). All participants have undergone high-resolution CT scan of the lumbar spine in the same position. FT and FO were measured at L1-2 to L5-S1. Significant sagittal FO was noted in the stenosis males (L2-3 to L4-5) and females (L2-3 to L5-S1) compared to the controls. The prevalence of FT was remarkably greater in the stenosis males (L4-5, L5-S1) and females (L3-4, L5-S1) compared to their counterparts in the control group. Our results also showed that FT (L3-4 to L5-S1) increases approximately 2.9 times the likelihood for DLSS development. This study indicates that FO and FT in the lower lumbar spine are significantly associated with DLSS.

Pedicle Morphometry Variations in Individuals with Degenerative Lumbar Spinal Stenosis.

The aim of this study was to compare pedicle dimensions in degenerative lumbar spinal stenosis (DLSS) with those in the general population. A retrospective computerized tomography (CT) study for lumbar vertebrae (L1 to L5) from two sample populations was used. The first included 165 participants with symptomatic DLSS (age range: 40-88 years, sex ratio: 80 M/85 F), and the second had 180 individuals from the general population (age range: 40-99 years, sex ratio: 90 M/90 F). Both males and females in the stenosis group manifested significantly greater pedicle width than the control group at all lumbar levels (P < 0.05). In addition, pedicle heights for stenosis females were remarkably smaller on L4 and L5 levels compared to their counterparts in the control group (P < 0.001). Males have larger pedicles than females for all lumbar levels (P < 0.001). Age and BMI did not demonstrate significant association with pedicle dimensions. Our outcomes indicate that individuals with DLSS have larger pedicle widths than the control group. More so, pedicle dimensions are gender-dependent but independent of age and BMI.

Is Lumbosacral Transitional Vertebra Associated with Degenerative Lumbar Spinal Stenosis?

The aim of this study was to shed light on the association between lumbosacral transitional vertebra (LSTV) and degenerative lumbar spinal stenosis (DLSS). A cross-sectional retrospective study was performed on 165 individuals that were diagnosed with clinical picture of DLSS (age range: 40-88 years; sex ratio: 80M/85F) and 180 individuals without DLSS related symptoms (age range: 40-99 years; sex ratio: 90M/90F). All participants had undergone high-resolution CT scan for the lumbar region in the same position. We also used the volume rendering method to obtain three-dimensional CT images of the lumbosacral area. Both males and females in the stenosis group manifest greater prevalence of LSTV than their counterparts in the control group (P<0.001). Furthermore, the presence of LSTV increases the likelihood of degenerative spinal stenosis (odds ratio= 3.741, P<0.001). In the control group, LSTV was more common in males, and sacral slope angle of males was significantly greater in LSTV group compared to non-LSTV. This study indicates that LSTV was significantly associated with symptomatic DLSS.

Lumbar Schmorl's Nodes and Their Correlation with Spine Configuration and Degeneration.

The aim of this study was to reveal whether demographic aspect, vertebral morphometry, and spine degeneration are associated with lumbar Schmorl's nodes (SNs). A retrospective cross-sectional study was performed using data from the Department of Radiology (Carmel, Medical Center, Israel) for 180 individuals: age range between 40 and 99 years; 90 males and 90 females. All participants had undergone high-resolution CT scans for abdominal diagnostic purposes in the same supine position prior to our study, which enabled the processing of the scans in all planes and allowed a 3D reconstruction of the lower lumbar region. Eighty individuals (44.4%) had at least one SN along the lumbar spine, particularly at L3-4 level (30%). Vertebral body length (L1 to L3) and width (L1 and L4) were significantly greater in the SNs group compared to non-SNs group. On contrast, disc height (L3-4 and L4-5) was significantly lesser in SNs group than non-SNs group. SNs was significantly associated with smoking (X 2= 4.436, P=0.02) and degenerative lumbar spinal stenosis (X 2= 5.197, P=0.038). Moreover, the prevalence of SN was significantly greater in individuals with vacuum phenomenon and osteophytes formation (L1-2 to L4-5 levels). This study indicates that vacuum phenomenon on L3-4 (OR: 4.7, P=0.034), smoking habit (OR: 3.2, P=0.003), disc height loss of L4-5 (OR: 0.798, P=0.008), vertebral body length of L1 (OR: 1.37, P<0.001), and age (OR: 1.05, P=0.002) increase the probability of developing lumbar SNs.

In the quest for degenerative lumbar spinal stenosis etiology: the Schmorl's nodes model.

BACKGROUND: Degenerative lumbar spinal stenosis (DLSS) is a common health problem in the elderly and usually associated with three-joint complex degeneration. Schmorl's nodes (SNs) are described as vertical herniation of the disc into the vertebral body through a weakened part of the end plate that can lead to disc degeneration. Since SNs can harm the spine unit stability, the association between DLSS and SNs is expected. The aim of this study is to shed light on the relationship between degenerative lumbar spinal stenosis and SNs. METHODS: Two groups of individuals were studied: the first included 165 individuals with DLSS (age range: 40-88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms (age range: 40-99, sex ratio: 90 M/90 F). The presence or absence of SNs on the cranial and caudal end plate surfaces at the lumbosacral region (from L1 to S1 vertebra) was recorded, using CT images (Brilliance 64 Philips Medical System, Cleveland Ohio, thickness of the sections was 1-3 mm and MAS, 80-250). Chi-Square test was taken to compare the prevalence of SNs between the study groups (control and stenosis) by lumbar disc level, for each gender separately. Multivariable logistic regression analysis was also used to determine the association between DLSS and SNs. RESULTS: The prevalence rate of SNs was significantly greater in the stenosis males (L1-2 to L5-S1) and females (L4-5 and L4-S1) compared to their counterparts in the control (P < 0.001). In addition, the presence of SNs in both males and females was found to increase the likelihood for DLSS. CONCLUSIONS: Our results indicate that SNs prevalence is significantly greater in the DLSS group compared to the control. Furthermore, SNs are strongly associated with DLSS.

Paraspinal muscles density: a marker for degenerative lumbar spinal stenosis?

BACKGROUND: The condition of paraspinal muscles is known to be associated with some variables such as age, gender, and low back pain. It is generally agreed that these muscles play an important role in the stability and functional movements of the lumbar vertebral column. Although spinal instability has been shown to play an essential role in degenerative lumbar spinal stenosis (DLSS), the role of paraspinal muscles remains elusive. The main purpose of this study was to shed light on the relationship between the condition of paraspinal muscles and symptomatic DLSS. METHODS: Two sample populations were studied. The first included 165 individuals with DLSS (age range: 40-88, sex ratio: 80 M/85 F) and the second 180 individuals without spinal stenosis related symptoms and low back pain (age range: 40-99, sex ratio: 90 M/90 F). Measurements were taken at the middle part of L3 vertebral body, using CT axial images (Philips Brilliance 64). Muscles density was measured in Hounsfield units (HU) using a 50 mm2 circle of the muscle mass at three different locations and the mean density was then calculated. The cross-sectional area (CSA) was also measured using the quantitative CT angiography method. Analysis of Covariance (adjusted for body mass index and age) was performed in order to determine the relationship between the condition of paraspinal muscles and symptomatic DLSS. RESULTS: Individuals in the stenosis group had higher muscle density as compared to the control group. The CSA values for the erector spinae (both sexes) and psoas (males) muscles were significantly greater in the stenosis group as compared to their counterparts in the control group. Additionally, density of multifidus (both sexes) and erector spinae (males) muscles was significantly associated with symptomatic DLSS. CONCLUSIONS: Our results show that individuals with symptomatic DLSS manifest greater paraspinal muscles density and CSA (erector spinae), compared to the control group. Density of multifidus increases the likelihood of symptomatic DLSS.

Vertebral Hemangiomas and Their Correlation With Other Pathologies.

STUDY DESIGN: This cross-sectional study was carried out on 196 adults (98 men and 98 women), aged between 18 and 91 years. OBJECTIVE: To examine whether vertebral hemangiomas (VHs) are associated with other spinal pathologies, metabolic diseases, cardiovascular diseases, cancer and past trauma, to shed light on their possible pathophysiology. SUMMARY OF BACKGROUND DATA: VHs are the most common form of benign tumors in the spine. Their association with spinal and systemic pathologies has not yet been systematically studied. METHODS: Clinical data were gathered from full spine CT scans and medical records. RESULTS: VHs were significantly associated with disc lesions (P = 0.004), past trauma (P = 0.037), diabetes (χ = 5.179, P = 0.023), cardio-vascular diseases (χ = 8.625, P = 0.003), and cancer (χ = 5.820, P = 0.016), but not with obesity. Only medium-large size VHs were significantly associated with osteoporosis (χ = 6.695, P = 0.010). CONCLUSION: The pattern of diseases related to VHs suggests a common cause for VH, namely, a disruption of vascular flow in the microvessels (accompanied by endothelium damage) within the vertebral body, eventually resulting in hypervascularization. LEVEL OF EVIDENCE: 4.

The Lumbar Lordosis in Males and Females, Revisited.

BACKGROUND: Whether differences exist in male and female lumbar lordosis has been debated by researchers who are divided as to the nature of variations in the spinal curve, their origin, reasoning, and implications from a morphological, functional and evolutionary perspective. Evaluation of the spinal curvature is constructive in understanding the evolution of the spine, as well as its pathology, planning of surgical procedures, monitoring its progression and treatment of spinal deformities. The aim of the current study was to revisit the nature of lumbar curve in males and females. METHODS: Our new automated method uses CT imaging of the spine to measure lumbar curvature in males and females. The curves extracted from 158 individuals were based on the spinal canal, thus avoiding traditional pitfalls of using bone features for curve estimation. The model analysis was carried out on the entire curve, whereby both local and global descriptors were examined in a single framework. Six parameters were calculated: segment length, curve length, curvedness, lordosis peak location, lordosis cranial peak height, and lordosis caudal peak height. PRINCIPAL FINDINGS: Compared to males, the female spine manifested a statistically significant greater curvature, a caudally located lordotic peak, and greater cranial peak height. As caudal peak height is similar for males and females, the illusion of deeper lordosis among females is due partially to the fact that the upper part of the female lumbar curve is positioned more dorsally (more backwardly inclined). CONCLUSIONS: Males and females manifest different lumbar curve shape, yet similar amount of inward curving (lordosis). The morphological characteristics of the female spine were probably developed to reduce stress on the vertebral elements during pregnancy and nursing.

A new technique for stabilization of injuries at C2-C3 in young children.

BACKGROUND: Reported surgical treatment for injuries and instabilities of the paediatric cervical spine most commonly involves posterior fusion with internal fixation, usually posterior wiring. PURPOSE: To present a new simple technique of stabilization without fusion of the upper cervical spine of young children. STUDY DESIGN: A technical report. METHODS: Detailed description of the surgical procedure carried out for stabilizing an unstable flexion-distraction injury in a 23 month-old toddler, with severe head injury and pneumothorax is presented. RESULTS: A rare unstable flexion-distraction injury in the upper cervical spine of a toddler was successfully treated with a posterior Number 2 Vicryl (polyglactin 910) suture fixation, with good healing of the ligaments and endplates, without fusion. Preservation of motion was achieved without obvious instability at 63 months post-surgery. CONCLUSIONS: In selected cases of cervical spine injuries in the young paediatric population, a limited approach to the injured spinal segments and simple stabilization using suitable degradable sutures, can provide sufficient stability until healing occurs. ADVANTAGES: fusion is avoided, growth disturbances are prevented and spinal motion maintained.

Malocclusion in early anatomically modern human: a reflection on the etiology of modern dental misalignment.

Malocclusions are common in modern populations. Yet, as the study of occlusion requires an almost intact dentition in both the maxilla and mandible, searching for the ultimate cause of malocclusion is a challenge: relatively little ancient material is available for research on occlusal states. The Qafzeh 9 skull is unique, as its preserved dentition allowed us to investigate the presence and manifestations of malocclusion. The aim of this study was thus to examine the occlusal condition in the Qafzeh 9 specimen in light of modern knowledge regarding the etiology of malocclusion. We revealed a pathologic occlusion in the Qafzeh 9 skull that probably originated in the early developmental stage of the dentition, and was aggravated by forces applied by mastication. When arch continuity is interrupted due to misalignment of teeth as in this case, force transmission is not equal on both sides, causing intra-arch outcomes such as mesialization of the teeth, midline deviation, rotations and the aggravation of crowding. All are evident in the Qafzeh 9 skull: the midline deviates to the left; the incisors rotate mesio-buccally; the left segment is constricted; the left first molar is buccally positioned and the left premolars palatally tilted. The inter-arch evaluation revealed anterior cross bite with functional shift that might affect force transmission and bite force. In conclusion, the findings of the current study suggest that malocclusion of developmental origin was already present in early anatomically modern humans (AMH) (the present case being the oldest known case, dated to ca. 100,000 years); that there is no basis to the notion that early AMH had a better adjustment between teeth and jaw size; and that jaw-teeth size discrepancy could be found in prehistoric populations and is not a recent phenomenon.

Socioeconomic and physical characteristics of individuals with degenerative lumbar spinal stenosis.

STUDY DESIGN: A descriptive study of the association between demographic factors, and physical characteristics, and degenerative lumbar spinal stenosis (DLSS). OBJECTIVE: To shed light on the association between socioeconomic parameters, physical characteristics, and DLSS. SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis is a prevalent and disabling condition in the aging population. DLSS is considered to be the most common type and is essentially associated with disc disease, facet joint arthrosis, ligamentum flavum thickening, and osteophyte formation. Although there is ample information regarding the association between body mass index, cardiovascular disorders, smoking habits, and disc disease, very little is known about their association with DLSS. Data on the association of body physique (e.g., height and weight) and DLSS are limited. METHODS: Two sample populations were studied. The first included 165 individuals with DLSS (mean age, 64 ± 9.9 yr) and the second 180 individuals without spinal stenosis related symptoms (mean age, 62.5 ± 12.6 yr). An evaluation of the cross-sectional area of the dural sac and degenerative listhesis for all participants was performed using computed tomographic lumbar spine images, obtained by Philips EBW station (Brilliance 64, Philips Medical System, Cleveland, OH). All participants were interviewed to obtain demographic, physical, and health data. Independent t test, Mann-Whitney and χ tests were used to determine the association between parametric and nonparametric variables and DLSS. Logistic regression analysis was carried out to reveal predicting variables for DLSS. RESULTS: Females with stenosis were significantly heavier and shorter than their counterparts in the control group. We also noticed that they delivered babies more often than those in the control group. Prevalence of individuals experiencing diabetes mellitus was significantly higher in the males with stenosis than control group. In the stenosis group, the frequencies of individuals engaged in heavy manual labor (males) and housekeeping (females) were significantly higher than that of their counterparts in the control group. CONCLUSION: Heavy manual labor and diabetes mellitus in males and housekeeping (females) play major roles in the genesis of DLSS.

Intracranial volume, cranial thickness, and hyperostosis frontalis interna in the elderly.

OBJECTIVES: According to the "brain reserve hypothesis," a larger premorbid brain protects against the development of dementia. The aim of this study was to reveal a possible pathophysiology of brain degenerative diseases by studying intracranial bone lesions that act to reduce intracranial volume (ICV), such as hyperostosis frontalis interna (HFI). METHODS: Three hundred and eighty postmenopausal females (aged 60+) who had undergone a head computerized tomography scan (Brilliance 64, Philips Healthcare, Cleveland, OH) at the Carmel Medical Center, Haifa, Israel, before the study were included. The subjects were divided into four groups according to their degree of HFI. Six measurements of the skull and brain were taken. RESULTS: As HFI becomes more severe, the cranial bone thickness and cranial bone volume increase. This process is accompanied by a decrease in ICV. In none of the HFI groups studied there was a significant association between ICV and cranial bone thickness. The inter-relationships between the various thickness parameters are not disturbed by the degree of HFI. CONCLUSION: HFI is accompanied by an increase in thickness of all calvarial bones and reduced ICV. In addition, the thickening process initiated by HFI is synchronized among the calvarial bones. Presence of HFI suggests a decrease in brain volume and has a major clinical significance as it may indicate the beginning of degenerative processes of the brain. In addition, as females age, their skulls tend to develop more robust characteristics.

Internal stabilization of a flexion-distraction injury of the upper cervical spine of a toddler: a new technique and literature review.

STUDY DESIGN: A case report and literature review. OBJECTIVE: To present a new and simple technique of fixation without fusion of a rare unstable Salter-Harris type I injury in the upper cervical spine of a 23-month-old toddler. SUMMARY OF BACKGROUND DATA: Surgical treatment of unstable pediatric cervical spine injuries most commonly involves posterior fusion with internal fixation, usually posterior wiring. METHODS: Detailed description of the surgical procedure carried out for fixating an unstable flexion-distraction injury in a 23-month-old toddler, with severe head injury and pneumothorax, is presented. RESULTS: A rare unstable flexion-distraction injury in the upper cervical spine of a toddler was successfully treated with a posterior Number 2 Vicryl (polyglactin 910; ETHICON Division of Johnson & Johnson) suture fixation, with good healing of the ligaments and end plates, without fusion. Preservation of motion was achieved without obvious instability at 28 months postsurgery. CONCLUSION: In selected cases of cervical spine injuries in the young pediatric population, simple stabilization of the spine using degradable Number 2 Vicryl (polyglactin 910) sutures with minimal exposure can provide sufficient stability until healing occurs. Advantages are that fusion is avoided and motion preserved.

Hyperostosis frontalis interna: what does it tell us about our health?

OBJECTIVES: To examine whether the prevalence and severity of hyperostosis frontalis interna (HFI) has significantly changed during the past 100 years. METHODS: Two female populations, 100 years apart, were studied; 992 historic and 568 present day females. Detection of HFI was carried out via direct observation or CT images (Brilliance 64, Philips Medical Systems, Cleveland, Ohio). HFI was graded according to Hershkovitz et al.'s (1999) 4-scale definition and according May et al.'s (2010c) 3-scale definition. RESULTS: Following correction for age, present day females manifested a significantly higher HFI prevalence compared with historic females (P < 0.05). The risk of developing HFI was found to be approximately 2.5 times greater in present day females compared with females living 100 years ago (P < 0.05). In the young age cohort, present day females manifested a significantly higher prevalence of HFI type B (P < 0.05), whereas in the old age cohort, a significant difference in the prevalence of HFI types C and D was noted between the two groups (P < 0.05). HFI tended to appear at a younger age in the present population. The last two decades has witnessed an increase in HFI prevalence(from 55.6% to 75%). CONCLUSIONS: HFI prevalence has increased during the last century, especially among young individuals, possibly indicating a profound change in human fertility patterns, together with the introduction of various hormonal treatments) and new dietary habits.

A tale of pseudo tail.

STUDY DESIGN: A case report. OBJECTIVE: To report on an interesting case of a symptomatic human pseudo tail in a 7-year-old girl, who had a lordotic deformity of the coccyx due to partial segmentation. SUMMARY OF BACKGROUND DATA: Caudal appendages are uncommon congenital malformations classified into two categories, true tails and pseudo tails, usually treated by surgical resection. Protrusion of the coccygeal vertebrae is considered the most common cause of pseudo tail. METHODS: Summary of the surgical management, as well as an x-ray film of the coccyx 8 years postoperatively, is presented. RESULTS: Total resection of the coccyx was successfully performed and all preoperative complaints of the patient were resolved shortly after the surgery. Follow-up 8 years later revealed regrowth of a small coccygeal bone, in normal alignment. CONCLUSION: Segmentation failure of the coccyx vertebrae may lead to an abnormal position of the coccyx that may interfere with daily life and therefore require coccygectomy. A newly developed coccygeal bone, in normal alignment, may be present at site after several years.