Surgical treatments for coccydynia

For people who have persistent pain that is not alleviated or well-controlled with conservative treatment, surgical removal of the coccyx (coccygectomy) is an option.

This surgery is rarely performed, and the procedure is not even included in most spine surgery textbooks. It is, however, a relatively simple operation.

Surgical approach

• A one to two-inch incision is made right over the top of the coccyx, which is located directly under the skin and subcutaneous fat tissue. There are no muscles to dissect away.

• The covering over the bone (the periosteum) is then dissected away from the bone starting on the back and carried around the front. Staying in this plane of tissue is very safe, and allows the coccyx to be dissected free and then separated from the sacrum.

• The coccyx is then removed and can be sent to pathology if there is any question as to whether or not it contains a tumor.

The operation takes about thirty minutes to perform and can be done on an outpatient basis. The most difficult part of the operation is that it takes a long time for the patient to get better. Generally, it takes three months to a year after the surgery before patients see any relief from their symptoms, and of course sitting is very difficult.

Success rates
The reliability of the operation is largely dependent on pre-operative patient selection. In highly selected patients, an 80% to 90% success rate can be expected.

Although there has been little literature devoted to coccygectomy, in 1985 Wray et. al. reported in the British Journal of Bone and Joint Surgery that they had a 90% success rate for the procedure in 20 patients.

Potential risks and complications
The main risk with the surgery is that during dissection the surgeon will get out of the subperiosteal plane around the bone. The rectum lies right in front of the coccyx, and if this is violated a severe infection could result. While it is unlikely, it is possible that if this were to happen a diverting colostomy would be necessary to allow the rectum to heal.

Other potential risks include wound healing difficulties and/or local infection. Of course, continued pain post-operatively is always a possibility. Unlike most other spine surgeries, there are no significant nerve roots in the region that would be at risk.

By: Richard Staehler, MD
April 4, 2000