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

vertebral column The spinal column, also known as the vertebral column, spine or backbone, is the core part of the axial skeleton in vertebrates. The vertebral column is the defining and eponymous characteristic of the vertebrate. The spinal column is a segmente ...

in all

ape Apes (collectively Hominoidea ) are a superfamily of Old World simians native to sub-Saharan Africa and Southeast Asia (though they were more widespread in Africa, most of Asia, and Europe in prehistory, and counting humans are found global ...

s, and analogous structures in certain other mammals such as

horses The horse (''Equus ferus caballus'') is a domesticated, one-toed, hoofed mammal. It belongs to the taxonomic family Equidae and is one of two extant subspecies of ''Equus ferus''. The horse has evolved over the past 45 to 55 milli ...

. In tailless

primates Primates is an order of mammals, which is further divided into the strepsirrhines, which include lemurs, galagos, and lorisids; and the haplorhines, which include tarsiers and simians ( monkeys and apes). Primates arose 74–63 ...

(e.g.

human Humans (''Homo sapiens'') or modern humans are the most common and widespread species of primate, and the last surviving species of the genus ''Homo''. They are Hominidae, great apes characterized by their Prehistory of nakedness and clothing ...

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'' (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 Family (biology), superfamily of Old World simians native to sub-Saharan Africa and Southeast Asia (though they were more widespread in Africa, most of Asia, and Europe in prehistory, and counting humans ...

),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. 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 capa ...

as ''tailfan''. It comprises three to five separate or fused coccygeal vertebrae below the

sacrum The sacrum (: sacra or sacrums), in human anatomy, is a 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 of the pelvic cavity, ...

, attached to the sacrum by a

fibrocartilaginous Fibrocartilage consists of a mixture of white fibrous tissue and Cartilage, cartilaginous tissue in various proportions. It owes its inflexibility and toughness to the former of these constituents, and its Elasticity (physics), elasticity to the ...

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 Amphiarthrosis, amphiarthrodial joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx. It is a slightly ...

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

Structure

The coccyx is formed of three, four or five rudimentary

vertebra Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...

e. It articulates superiorly with the

. 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 o ...

and

transverse process Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...

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 Each vertebra (: vertebrae) is an irregular bone with a complex structure composed of bone and some hyaline cartilage, that make up the vertebral column or spine, of vertebrates. The proportions of the vertebrae differ according to their spina ...

es. The first segment is the largest; it resembles the lowest sacral vertebra, 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 Standard anatomical terms of location are used to describe unambiguously the anatomy of humans and other animals. The terms, typically derived from Latin or Greek roots, describe something in its standard anatomical position. This position pro ...

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 The periosteum is a membr ...

and the levatores ani and supports part of the

rectum The rectum (: rectums or recta) is the final straight portion of the large intestine in humans and some other mammals, and the gut in others. Before expulsion through the anus or cloaca, the rectum stores the feces temporarily. The adult ...

. 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 The articular process or zygapophysis ( + apophysis) of a vertebra is a projection of the vertebra that serves the purpose of fitting with an adjacent vertebra. The actual region of contact is called the ''articular facet''.Moore, Keith L. et al. ...

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 other ...

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 (; : foramina, or foramens ; ) is an opening or enclosed gap within the dense connective tissue (bones and deep fasciae) of extant and extinct amniote animals, typically to allow passage of nerves, artery, ...

for the transmission of the posterior division 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 lower ...

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 i ...

s, to the coccygeus 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 The gluteus maximus is the main extensor muscle of the hip in humans. It is the largest and outermost of the three gluteal muscles and makes up a large part of the shape and appearance of each side of the hips. It is the single largest muscle in ...

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 an oval tube of skeletal muscle fibers. Distally, it is adherent to the skin surrounding the margin of the anus. It exhibits a resting state of tonical contraction and also contracts duri ...

; it may be divided in two.

Coccygeal fossa

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

and the

perineum The perineum (: perineums or perinea) in placentalia, placental mammals is the space between the anus and the genitals. The human perineum is between the anus and scrotum in the male or between the anus and vulva in the female. The perineum is ...

, located in the

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

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 an anatomical location in the human body which has an important role in urinary and anal continence, sexual function, and support of the pelvic organs. The pelvic floor includes muscles, both skeletal and ...

, next to the coccyx. The

has its origin 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 toge ...

, which is not always present. It extends over the caudal portion of the posterior surface of the

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; (2) thin discs of

fibrocartilage 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 ...

; (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 the ...

, coccygeus, iliococcygeus, and pubococcygeus, anococcygeal raphe. Attached to the posterior side is the

, which extends the

thigh In 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 bone tissu ...

at the hip joint. The

ligament A ligament is a type of fibrous connective tissue in the body that connects bones to other bones. It also connects flight feathers to bones, in dinosaurs and birds. All 30,000 species of amniotes (land animals with internal bones) have liga ...

s attached to the coccyx include the

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 d ...

s which are the continuations of the

and

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

s that extend along the entire spine. The lateral sacrococcygeal ligaments complete the

foramina In anatomy and osteology, a foramen (; : foramina, or foramens ; ) is an opening or enclosed gap within the dense connective tissue (bones and deep fasciae) of extant and extinct amniote animals, typically to allow passage of nerves, arter ...

for the last sacral nerve. Some fibers of the sacrospinous and

sacrotuberous ligament 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 lowe ...

s (arising from the spine of the ischium 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 posterior bony protuberance on the superior ramus of the ischium. It ...

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, extending inferiorly from the apex of the conus medullaris to attach onto the coccyx. The filum terminale acts to anchor the spinal cord ...

, extends from the apex of the

conus ''Conus'' is a genus of venomous and predatory cone snails.Bouchet, P.; Gofas, S. (2015). Conus Linnaeus, 1758. In: MolluscaBase (2015). Accessed through: World Register of Marine Species at http://www.marinespecies.org/aphia.php?p=taxdetails&i ...

, and inserts on the coccyx.

Function

The coccyx is not entirely useless in humans, because it 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.

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 tumor, benign ...

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

). One very rare complication of coccygectomy is a type of perineal hernia known as a coccygeal hernia.

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 classical antiquity, ancient world from around 1500 BC to 300 BC. It is often roughly divided into the following periods: Mycenaean Greek (), Greek ...

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. "cuckoo";. the latter is attested in the writings of the Greek

physician A physician, medical practitioner (British English), medical doctor, or simply doctor is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through the Medical education, study, Med ...

Herophilus Herophilos (; ; 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 scientist to systematically p ...

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 somet ...

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 Andries van Wezel (31 December 1514 – 15 October 1564), latinized as Andreas Vesalius (), was an anatomist and physician who wrote '' De Humani Corporis Fabrica Libri Septem'' (''On the fabric of the human body'' ''in seven books''), which is ...

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 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). Riolan's explanation is not considered credible. 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 French ( or ) is a Romance languages, Romance language of the Indo-European languages, Indo-European family. Like all other Romance languages, it descended from the Vulgar Latin of the Roman Empire. French evolved from Northern Old Gallo-R ...

German German(s) may refer to: * Germany, the country of the Germans and German things **Germania (Roman era) * Germans, citizens of Germany, people of German ancestry, or native speakers of the German language ** For citizenship in Germany, see also Ge ...

and Dutch terms ''tailbone'', , and '.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'' (commonly abbreviated TA) is the international standard for human anatomy, human anatomical terminology. It is developed by the Federative International Programme on Anatomical Terminology (FIPAT) a program of the Inter ...

'',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

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