Coccygectomy for coccydynia: case series and review of literature

Spine (Phila Pa 1976). 2006 Jun 1;31(13):E414-20. doi: 10.1097/01.brs.0000219867.07683.7a.

Abstract

Study design: This is a case series in which case notes review and telephone interview update were used to assess the outcome following coccygectomy.

Objective: To correlate the clinical results of coccygectomy with histology and discography of the sacrococcygeal and intercoccygeal segments.

Summary of background data: Clinicians regard chronic disabling pain in the sacrococcygeal region with much dismay because of the reputed unpredictability of the treatment outcome.

Methods: A total of 38 patients had coccygectomy for intractable coccydynia, and 31 were available for follow-up. The excised specimen with intact sacrococcygeal joint was sent for histologic examination in 22 patients. There were 6 patients investigated using sacrococcygeal and intercoccygeal discography.

Results: Mean postoperative follow-up was 6.75 years (range 2-16). There were 16 patients who benefited highly from the surgery, and 6 benefited to some extent, giving an overall beneficial result of 71%. Of all specimens, 86.3% had histologic changes of degeneration. Moderate-to-severe degenerate changes in sacrococcygeal and intercoccygeal joints on histology were found in 54.5% of patients. Of these patients, 83.3% did well with surgery. Only 57.1% of those patients with mild changes did well. There were 2 patients who had positive discography, and both did well with surgery. Three patients had negative diskographies, and 2 of them had a poor result, and 1 had only some relief.

Conclusions: It is possible that degenerate changes in sacrococcygeal discs and/or intercoccygeal discs are associated with pain. Surgical results are better in those with a severe degree of degenerative change. Coccygectomy remains a successful treatment for a majority of severely disabled patients with coccydynia.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Coccyx / diagnostic imaging
  • Coccyx / pathology
  • Coccyx / surgery*
  • Female
  • Humans
  • Intervertebral Disc / diagnostic imaging
  • Intervertebral Disc / pathology
  • Intervertebral Disc / surgery
  • Male
  • Middle Aged
  • Orthopedic Procedures*
  • Pain / diagnostic imaging
  • Pain / pathology
  • Pain / physiopathology
  • Pain / surgery*
  • Radiography
  • Sacrum / diagnostic imaging
  • Sacrum / surgery
  • Severity of Illness Index