The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the

vertebral column The vertebral column, also known as the backbone or spine, is part of the axial skeleton. The vertebral column is the defining characteristic of a vertebrate in which the notochord (a flexible rod of uniform composition) found in all chordate ...

in all

ape Apes (collectively Hominoidea ) are a clade of Old World simians native to sub-Saharan Africa and Southeast Asia (though they were more widespread in Africa, most of Asia, and as well as Europe in prehistory), which together with its sister g ...

s, and analogous structures in certain other mammals such as horses. In tailless primates (e.g.

human Humans (''Homo sapiens'') are the most abundant and widespread species of primate, characterized by bipedalism and exceptional cognitive skills due to a large and complex brain. This has enabled the development of advanced tools, cultu ...

s and other

great ape The Hominidae (), whose members are known as the great apes or hominids (), are a taxonomic family of primates that includes eight extant species in four genera: '' Pongo'' (the Bornean, Sumatran and Tapanuli orangutan); ''Gorilla'' (the ...

s) since ''

Nacholapithecus ''Nacholapithecus kerioi'' was an ape that lived 14-15 million years ago during the Middle Miocene. Fossils have been found in the Nachola formation in northern Kenya. The only member of the genus ''Nacholapithecus'', it is thought to be a key g ...

'' (a

Miocene The Miocene ( ) is the first epoch (geology), geological epoch of the Neogene Period and extends from about (Ma). The Miocene was named by Scottish geologist Charles Lyell; the name comes from the Greek words (', "less") and (', "new") and mea ...

hominoid Apes (collectively Hominoidea ) are a clade of Old World simians native to sub-Saharan Africa and Southeast Asia (though they were more widespread in Africa, most of Asia, and as well as Europe in prehistory), which together with its sister g ...

),Nakatsukasa 2004, ''Acquisition of bipedalism'' (Se
Fig. 5
entitled ''First coccygeal/caudal vertebra in short-tailed or tailless primates.''.) the coccyx is the remnant of a

vestigial tail The tail is the section at the rear end of certain kinds of animals’ bodies; in general, the term refers to a distinct, flexible appendage to the torso. It is the part of the body that corresponds roughly to the sacrum and coccyx in mammals ...

. In animals with bony tails, it is known as ''tailhead'' or ''dock'', in

bird anatomy Bird anatomy, or the physiological structure of birds' bodies, shows many unique adaptations, mostly aiding flight. Birds have a light skeletal system and light but powerful musculature which, along with circulatory and respiratory systems cap ...

as ''tailfan''. It comprises three to five separate or fused coccygeal vertebrae below the sacrum, attached to the sacrum by a

fibrocartilaginous Fibrocartilage consists of a mixture of white fibrous tissue and cartilaginous tissue in various proportions. It owes its inflexibility and toughness to the former of these constituents, and its elasticity to the latter. It is the only type of ...

joint A joint or articulation (or articular surface) is the connection made between bones, ossicles, or other hard structures in the body which link an animal's skeletal system into a functional whole.Saladin, Ken. Anatomy & Physiology. 7th ed. McGraw- ...

, the

sacrococcygeal symphysis The sacrococcygeal symphysis (sacrococcygeal articulation, articulation of the sacrum and coccyx) is an amphiarthrodial joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx. It is a slightly moveable joint ...

, which permits limited movement between the sacrum and the coccyx.

Structure

The coccyx is formed of three, four or five rudimentary

vertebra The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...

e. It articulates superiorly with the sacrum. In each of the first three segments may be traced a rudimentary body and

articular The articular bone is part of the lower jaw of most vertebrates, including most jawed fish, amphibians, birds and various kinds of reptiles, as well as ancestral mammals. Anatomy In most vertebrates, the articular bone is connected to two oth ...

and

transverse process The spinal column, a defining synapomorphy shared by nearly all vertebrates,Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...

es; the last piece (sometimes the third) is a mere nodule of bone. The transverse processes are most prominent and noticeable on the first coccygeal segment. All the segments lack pedicles, laminae and

spinous process The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristic ...

es. The first segment is the largest; it resembles the lowest

sacral vertebra The sacrum (plural: ''sacra'' or ''sacrums''), in human anatomy, is a large, triangular bone at the base of the spine that forms by the fusing of the sacral vertebrae (S1S5) between ages 18 and 30. The sacrum situates at the upper, back part ...

, and often exists as a separate piece; the remaining ones diminish in size rostrally. Most anatomy books incorrectly state that the coccyx is normally fused in adults. It has been shown that the coccyx may, in some people, consist of up to five separate bony segments, the most common configuration being two or three segments.

Surfaces

The anterior surface is slightly concave and marked with three transverse grooves which indicate the junctions of the different segments. It gives attachment to the

anterior sacrococcygeal ligament The anterior sacrococcygeal ligament or ventral sacrococcygeal ligament consists of a few irregular fibers, which descend from the anterior surface of the sacrum to the front of the coccyx, blending with the periosteum.Morris (2005), p 59 This sh ...

and the

levatores ani The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of t ...

and supports part of the rectum. The posterior surface is convex, marked by transverse grooves similar to those on the anterior surface, and presents on either side a linear row of tubercles – the undeveloped articular processes of the coccygeal vertebrae. Of these, the superior pair are the largest, and are called the

coccygeal cornu The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates (e.g. humans and othe ...

a they project caudally, and articulate with the cornua of the sacrum, and on either side complete the

foramen In anatomy and osteology, a foramen (;Entry "foramen"
in

for the transmission of the

posterior division The dorsal ramus of spinal nerve (or posterior ramus of spinal nerve, or posterior primary division) is the posterior division of a spinal nerve. The dorsal ramus (Latin for branch, plural ''rami'' ) is the dorsal branch of a spinal nerve that fo ...

of the fifth sacral nerve.

Borders

The lateral borders are thin and exhibit a series of small bony protrusions, which represent the transverse processes of the coccygeal vertebrae. Of these, the first is the largest; it is flattened anteriorly, and often extends to join the lower part of the thin lateral edge of the sacrum, thus completing the foramen for the transmission of the anterior division of the fifth sacral nerve; the others diminish in size from caudally, and are often lacking. The borders of the coccyx are narrow, and give attachment on either side to the

sacrotuberous The sacrotuberous ligament (great or posterior sacrosciatic ligament) is situated at the lower and back part of the pelvis. It is flat, and triangular in form; narrower in the middle than at the ends. Structure It runs from the sacrum (the low ...

and

sacrospinous ligament The sacrospinous ligament (small or anterior sacrosciatic ligament) is a thin, triangular ligament in the human pelvis. The base of the ligament is attached to the outer edge of the sacrum and coccyx, and the tip of the ligament attaches to the s ...

s, to the

coccygeus The coccygeus muscle or ischiococcygeus is a muscle of the pelvic floor, located posterior to levator ani and anterior to the sacrospinous ligament. Structure The coccygeus muscle is posterior to levator ani and anterior to the sacrospinous li ...

and

levator ani The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of the ...

in front of the ligaments, and to the gluteus maximus behind them.

Apex

The apex is rounded, and has attached to it the tendon of the

external anal sphincter The external anal sphincter (or sphincter ani externus ) is a flat plane of skeletal muscle fibers, elliptical in shape and intimately adherent to the skin surrounding the margin of the anus. Anatomy The external anal sphincter measures about 8 ...

; it may be divided in two.

Coccygeal fossa

The coccygeal fossa is a shallow depression on the posterior surface between the sacrum and the

perineum The perineum in humans is the space between the anus and scrotum in the male, or between the anus and the vulva in the female. The perineum is the region of the body between the pubic symphysis (pubic arch) and the coccyx (tail bone), includi ...

, located in the

intergluteal cleft The intergluteal cleft or just gluteal cleft, also known by a number of synonyms, including natal cleft, butt crack, and cluneal cleft, is the groove between the buttocks that runs from just below the sacrum to the perineum, so named because it f ...

that runs from just below the sacrum to the

. It is not consistently present in all humans. The coccygeal fossa marks the deepest part of the

pelvic floor The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus muscle, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the lev ...

, next to the coccyx. The

has its

origin Origin(s) or The Origin may refer to: Arts, entertainment, and media Comics and manga * ''Origin'' (comics), a Wolverine comic book mini-series published by Marvel Comics in 2002 * ''The Origin'' (Buffy comic), a 1999 ''Buffy the Vampire Sl ...

here.

Extensor coccygis

The extensor coccygis is a slender

muscle fascicle A muscle fascicle is a bundle of skeletal muscle fibers surrounded by perimysium, a type of connective tissue. Structure Muscle cells are grouped into muscle fascicles by enveloping perimysium connective tissue. Fascicles are bundled togethe ...

, which is not always present. It extends over the caudal portion of the posterior surface of the sacrum and coccyx. It arises by tendinous fibers from the last segment of the sacrum, or first piece of the coccyx, and passes downward to be inserted into the lower part of the coccyx. It is an evolutionary relic of the extensor muscle of the caudal vertebrae of other animals, enabling limited coccygeal motion.

Sacrococcygeal and intercoccygeal joints

The joints are variable and may be: (1)

synovial joints A synovial joint, also known as diarthrosis, joins bones or cartilage with a fibrous joint capsule that is continuous with the periosteum of the joined bones, constitutes the outer boundary of a synovial cavity, and surrounds the bones' articula ...

; (2) thin discs of fibrocartilage; (3) intermediate between these two; (4) ossified.

Attachments

The anterior side of the coccyx has attachments to the

levator ani muscle The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of t ...

iliococcygeus The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of t ...

, and

pubococcygeus The levator ani is a broad, thin muscle group, situated on either side of the pelvis. It is formed from three muscle components: the pubococcygeus, the iliococcygeus, and the puborectalis. It is attached to the inner surface of each side of t ...

anococcygeal raphe The anococcygeal body (anococcygeal ligament, or anococcygeal raphe) is a fibrous median raphe in the floor of the pelvis, which extends between the coccyx and the margin of the anus. It is composed of fibers of the levator ani muscle that unite ...

. Attached to the posterior side is the gluteus maximus, which extends the

thigh In human anatomy, the thigh is the area between the hip ( pelvis) and the knee. Anatomically, it is part of the lower limb. The single bone in the thigh is called the femur. This bone is very thick and strong (due to the high proportion of ...

at the hip joint. The ligaments attached to the coccyx include the anterior and

posterior sacrococcygeal ligament The posterior sacrococcygeal ligament or dorsal sacrococcygeal ligamentOMD: Definition is a ligament which stretches from the sacrum to the coccyx and thus dorsally across the sacrococcygeal symphysis shared by these two bones. This ligament is di ...

s which are the continuations of the anterior and

posterior longitudinal ligament The posterior longitudinal ligament is a ligament connecting the posterior surfaces of the vertebral bodies of all of the vertebrae. It weakly prevents hyperflexion of the vertebral column. It also prevents posterior spinal disc herniation, altho ...

s that extend along the entire spine. The

lateral sacrococcygeal ligament In the human body, the lateral sacrococcygeal ligaments is a pair of ligaments stretching from the lower lateral angles of the sacrum to the transverse processes of the first coccygeal vertebra. Together with the anterior, posterior, and inter ...

s complete the

foramina In anatomy and osteology, a foramen (;Entry "foramen"
in

for the last sacral nerve. Some fibers of the sacrospinous and sacrotuberous ligaments (arising from the

spine of the ischium The ischial spine is part of the posterior border of the body of the ischium bone of the pelvis. It is a thin and pointed triangular eminence, more or less elongated in different subjects. Structure The pudendal nerve travels close to the isch ...

and the

ischial tuberosity The ischial tuberosity (or tuberosity of the ischium, tuber ischiadicum), also known colloquially as the sit bones or sitz bones, or as a pair the sitting bones, is a large swelling posteriorly on the superior ramus of the ischium. It marks th ...

respectively) also attach to the coccyx. An extension of the

pia mater Pia mater ( or ),Entry "pia mater"
in
filum terminale The filum terminale ("terminal thread") is a delicate strand of fibrous tissue, about 20 cm in length, proceeding downward from the apex of the conus medullaris. It is one of the modifications of pia mater. It gives longitudinal support to th ...

, extends from the apex of the conus, and inserts on the coccyx.

Function

The coccyx is not entirely useless in humans, based on the fact that the coccyx has attachments to various muscles, tendons and ligaments. However, these muscles, tendons and ligaments are also attached at many other points, to stronger structures than the coccyx. It is doubtful that the coccyx attachments are important to the well-being of humans, given the large number of

coccygectomy Coccygectomy is a surgical procedure in which the coccyx or tailbone is removed. It is considered a required treatment for sacrococcygeal teratoma and other germ cell tumors arising from the coccyx. Coccygectomy is the treatment of last resort for ...

procedures performed annually to treat

coccydynia Coccydynia is a medical term meaning pain in the coccyx or tailbone area, often brought on by a fall onto the coccyx or by persistent irritation usually from sitting. Synonyms Coccydynia is also known as coccygodynia, coccygeal pain, coccyx pain, ...

. Reviews of studies covering more than 700 coccygectomies found the operation was successful in relieving pain in 84% of cases.Coccygektomi kan være en behandlingsmulighed ved kronisk coccygodyni (Coccygectomy may be a treatment option for chronic coccydynia) Ugeskr Læger 2011 Feb 14; 173(7): 495-500. In Danish. Aarby, Nanett Skjellerup (1), Trollegaard, Anton Mitchell (2) and Hellberg, Steen (2) https://www.coccyx.org/medabs/aarby.htm 12% of the time, the only major complication faced was infection due to the proximity to the anus. One notable complication of coccygectomy is an increased risk of

perineal hernia Perineal hernia is a hernia involving the perineum ( pelvic floor). The hernia may contain fluid, fat, any part of the intestine, the rectum, or the bladder. It is known to occur in humans, dogs, and other mammals, and often appears as a sudden ...

Clinical significance

Injuring the coccyx can give rise to a painful condition called

and one or more of the bones or the connections thereof may be broken, fractured tailbone. A number of

tumor A neoplasm () is a type of abnormal and excessive growth of tissue. The process that occurs to form or produce a neoplasm is called neoplasia. The growth of a neoplasm is uncoordinated with that of the normal surrounding tissue, and persists ...

s are known to involve the coccyx; of these, the most common is

sacrococcygeal teratoma Sacrococcygeal teratoma (SCT) is a type of tumor known as a teratoma that develops at the base of the coccyx (tailbone) and is thought to be primarily derived from remnants of the primitive streak. Sacrococcygeal teratomas are benign 75% of the ...

. Both coccydynia and coccygeal tumors may require surgical removal of the coccyx (

). One very rare complication of coccygectomy is a type of

known as a coccygeal hernia.

History

Etymology

The term ''coccyx'' is derived from the

ancient Greek Ancient Greek includes the forms of the Greek language used in ancient Greece and the ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Dark Ages (), the Archaic p ...

word Klein, E. (1971). ''A comprehensive etymological dictionary of the English language. Dealing with the origin of words and their sense development thus illustration the history of civilization and culture.'' Amsterdam: Elsevier Science B.V. ''kokkyx'' "cuckoo";. the latter is attested in the writings of the Greek

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

Herophilus Herophilos (; grc-gre, Ἡρόφιλος; 335–280 BC), sometimes Latinised Herophilus, was a Greek physician regarded as one of the earliest anatomists. Born in Chalcedon, he spent the majority of his life in Alexandria. He was the first ...

to denote the end of the vertebral column.Hyrtl, J. (1880). ''Onomatologia Anatomica. Geschichte und Kritik der anatomischen Sprache der Gegenwart.'' Wien: Wilhelm Braumüller. K.K. Hof- und Universitätsbuchhändler. This Greek name for the

cuckoo Cuckoos are birds in the Cuculidae family, the sole taxon in the order Cuculiformes . The cuckoo family includes the common or European cuckoo, roadrunners, koels, malkohas, couas, coucals and anis. The coucals and anis are sometimes separ ...

was applied as the last three or four bones of the coccyx resemble the beak of this bird,Kraus, L.A. (1844). ''Kritisch-etymologisches medicinisches Lexikon'' (Dritte Auflage). Göttingen: Verlag der Deuerlich- und Dieterichschen Buchhandlung. when viewed from the side. This established etymological explanation can also be found in the writings of the 16th century anatomist

Andreas Vesalius Andreas Vesalius (Latinized from Andries van Wezel) () was a 16th-century anatomist, physician, and author of one of the most influential books on human anatomy, ''De Humani Corporis Fabrica Libri Septem'' (''On the fabric of the human body'' ' ...

who wrote: ''os cuculi, a similitudine rostri cuculi avis'' (the cuckoo bone shows a likeness to the beak of the cuckoo bird). Vesalius used the Latin expression ''os cuculi'', with ''os'', bone, , and ''cuculus'', the Latin name for the cuckoo. The 16th/17th century French anatomist

Jean Riolan the Younger Jean Riolan (the Younger) (15 February 1577 or 1580 – 19 February 1657) was a French anatomist who was an influential member of the Medical Faculty of Paris. His father, Jean Riolan (the Elder) (1539–1605) was also a noted French anatomist. Ri ...

gives a rather hilarious etymological explanation, as he writes: ''quia crepitus, qui per sedimentum exeunt, ad is os allisi, cuculi vocis similitudinem effingunt'' (because the sound of the farts that leave the anus and dash against this bone, shows a likeness to the call of the cuckoo). The latter is not considered as potential candidate. Besides ''os cuculi'', ''os caudae'',Schreger, C.H.Th.(1805). ''Synonymia anatomica. Synonymik der anatomischen Nomenclatur.'' Fürth: im Bureau für Literatur. with ''caudae'', of the tail is attested. This Latin expression might be the source of the English, French language,

German German(s) may refer to: * Germany (of or related to) ** Germania (historical use) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizens of Germany, see also German nationality law **Ge ...

and

Dutch Dutch commonly refers to: * Something of, from, or related to the Netherlands * Dutch people () * Dutch language () Dutch may also refer to: Places * Dutch, West Virginia, a community in the United States * Pennsylvania Dutch Country People E ...

terms ''tailbone'', ''l'os de la queue'', ''Schwanzbein'' and ''staartbeen''.Everdingen, J.J.E. van, Eerenbeemt, A.M.M. van den (2012). ''Pinkhof Geneeskundig woordenboek'' (12de druk). Houten: Bohn Stafleu Van Loghum. In the current official anatomic Latin nomenclature, ''

Terminologia Anatomica ''Terminologia Anatomica'' is the international standard for human anatomical terminology. It is developed by the Federative International Programme on Anatomical Terminology, a program of the International Federation of Associations of Anatomi ...

'',Federative Committee on Anatomical Terminology (FCAT) (1998). ''Terminologia Anatomica''. Stuttgart: Thieme ''coccyx'' and ''os coccygis'' is used.

Additional images

File:Gray404.png, The coccyx sits below the sacrum and behind the

pelvic cavity The pelvic cavity is a body cavity that is bounded by the bones of the pelvis. Its oblique roof is the pelvic inlet (the superior opening of the pelvis). Its lower boundary is the pelvic floor. The pelvic cavity primarily contains the reproduc ...

References

External links

* – "The Female Perineum: Osteology"
Coccydynia (coccyx pain, tailbone pain) at eMedicine
(Peer-reviewed medical chapter, available free online) {{Authority control Bones of the thorax Bones of the vertebral column Vestigial organs