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Results of Coccygectomy

Z Haddad* 


*Department of Trauma and Orthopaedic Surgery, Jersey General Hospital, Jersey, JE2 3QS, UK


Address for Correspondence

Z Haddad, FRCS Orth Glasg

P hone: 00441534442000
Fax: 00441534444229.


Aim: to evaluate the effectiveness of coccygectomy operations performed in Jersey General hospital.

Method: Coccygectomy was performed on 19 patients, who had failed to improve following more than 6 months of conservative management. The medical records of all patients and x-rays were reviewed retrospectively. All the patients completed a questionnaire describing their level of pain (on a visual analogue scale) and satisfaction with the result of surgery.

Results: Excellent results was reported in 15 (79%) , good results in 2 (10.5 %) and fair result in (10.5%) of cases. complications included one superficial infection and wound dehiscence, one sinus stich abcess.

Conclusion: Coccygectomy offers high success rate in relieving coccydynia. Irrespective of the cause.

J.Orthopaedics 2012;9(2)e9


coccygectomy, coccydynia, VAS (visual analogue scale).

Coccydynia (pain in the coccygeal area) is a relatively uncommon complaint in daily orthopaedic practice. It is most common around the fourth decade of life[1,2]. Coccydynia is more common in females, with female to male ratio around 5:1[3].the cause of coccydynia is either posttraumatic [3,4] or idiopathic and rarely postpartum. The pathology remains unclear. Investigations like x-ray and MRI scans does not normally add clues to the cause or pathology. Postachini and Massobrio[5] classified coccyx according to the degree of curvature and forward inclination into 4 types, with type four being coccyx subluxed at sacrococcygeal joint. The symptoms usually are pain when sitting specially on hard surfaces, and dull aching pain during rising up from bed or setting position to upright position [2,6]. Some patients describe pain during defecation. Careful examination of the area is required to rule out rectal or pararectal causes of pain and in rare cases the presence of tumours in the area.

Material and Methods::

We retrospectively reviewed the medical records and x-rays of 19 patients who had coccygectomy operation for treatment of recalcitrant coccydynia .All the operations were performed by the senior author (except one), in the years of 1997-2010. the sex distribution was 3 males and 16 females. the average age 37.2 years (range 17-53 years).all patients had persistent pain in the coccyx, the average referral time from the onset of symptoms was 15.4 months (range 4-36 m).All patients had conservative treatment including injections of steroid (average injections 1.8, range 0-5),the cause of symptoms was identified as traumatic in 10 (including one postpartum) idiopathic in 9 patient. All the operations were total coccygectomy carried out in prone position, through natal cleft approach, adequate hemostasis, wounds closed with subcuticular vicryl 3/0. All patients received IV antibiotic prophylaxis for 24 hours, 2 patients had antibiotics for 48 h. Most patients remained in hospital for two nights.  Patients were reviewed at 2 weeks, 3 months and majority at 6 months. A postal questionnaire was sent to all patients, asking the level of patient’s satisfaction and to estimate thier pain score on the visual analogue scale. All patients responded.


Excellent result was achieved in 15/19 - 79% (no pain or minimal discomfort, 0-1 on VAS), good result in 2/19 -10.5% (mild occasional pain, 2-4 on VAS), fair result 2/19- 10.5% (some improvement in pain,   > 4 score on VAS).No patient reported being same or worse than before. Post-operative complications included one superficial infection leading to wound dehiscence and re-operation for closure. One had sinus stitch abcess treated by stitch removal in clinic and oral antibiotics successfully. 3 patients had long standing back problems, only one had fair result the other 2 excellent result following surgery. There was no correlation between sacro-coccygeal angle on x-rays and symptoms. MRI scan was performed in 4 cases, one showed oedema around coccyx (could be following injection) as detailed in Table 1.  Injections of steroids is effective in temporary relief of pain, either with or without manipulation under anaesthesia.



The published rate of success following coccygectomy is reported to be higher than 70% [1,3,7-10],these figures were confirmed in few review publications [8,11,12}. In our retrospective review17 out of 19patients (90%) reported excellent and good results. The success rate was higher in the posttraumatic group of patients, where 87% reported excellent outcome compared with 66% in the idiopathic group, as reported by few authors [1,7,8] Our complications were two cases of wound infection including wound dehiscence; there were no cases of bowel damage or other complications. The X rays did not correlate with the symptoms; neither did four MRI scans and one bone scan. The radiographs were reviewed by the radiographer and the surgeon.

This study is limited by the low number of patients of this relatively uncommon condition. We had good recording of the conservative treatment prior to surgery, including the number of steroid injections received. We did not have recording of the visual analogue pain score before surgery.   This retrospective study on patients with coccydynia, confirms evidence that total coccygectomy can achieve pain relief in high percentage of patients (90% excellent and good results). Conclusion Coccygectomy offers high success rate in relieving coccydynia irrespective of the cause. It is more suucceful in the posttraumatic group. However conservative management should be tried first. In resistant cases coccygectomy good symotomatic relief. The authors declare that they have no conflict of interest.




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This is a peer reviewed paper 

Please cite as :Z Haddad ,Results of Coccygectomy

J.Orthopaedics 2012;9(2)e9




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