Coccygectomy for patients with chronic coccydynia: a prospective, observational study of 98 patients

Bone Joint J. 2016 Apr;98-B(4):526-33. doi: 10.1302/0301-620X.98B4.36641.


Aims: The purpose of this prospective study was to evaluate the outcomes of coccygectomy for patients with chronic coccydynia.

Patients and methods: Between 2007 and 2011, 98 patients underwent coccygectomy for chronic coccydynia. The patients were aged > 18 years, had coccygeal pain, local tenderness and a radiological abnormality, and had failed conservative management. Outcome measures were the Short Form 36 (SF-36), the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) for pain. Secondary analysis compared the pre-operative features and the outcomes of patients with successful and failed treatment, two years post-operatively. The threshold for success was based on a minimum clinically important difference (MCID) on the ODI of 20 points. All other patients, including those lost to follow-up, were classified as failures.

Results: There was significant improvement in all ten components of the SF-36 (p < 0.05), the ODI (23 points) and VAS (39 points) (p < 0.0001). A total of 69 patients (70.4%) met the designated MCID threshold for a successful outcome. The failure group consisted of 25 patients (25.5%) who did not reach the MCID and four (4.1%) who were lost to follow-up. Six patients (6.1%) in the failure group had ODI scores that were no better or worse than that pre-operatively. The patients in whom treatment failed had significantly worse pre-operative scores for the ODI (p = 0.04), VAS (p = 0.02) and on five of ten SF-36 components (p < 0.04). They also had a higher incidence of psychiatric disorders, pre-operative opiate use and more than three comorbidities.

Take home message: Coccygectomy for chronic coccydynia results in significant improvement in patient-reported outcomes at two years. Failure is associated with certain pre-operative characteristics such as psychiatric illness, poor quality of life features, higher levels of pain, and use of opiates.

Keywords: Coccydynia; coccygectomy; coccyx; sacrococcygeal injection.

Publication types

  • Observational Study

MeSH terms

  • Adult
  • Aged
  • Back Pain / rehabilitation
  • Back Pain / surgery*
  • Chronic Disease
  • Disability Evaluation*
  • Female
  • Humans
  • Lumbar Vertebrae
  • Male
  • Middle Aged
  • Pain Measurement
  • Patient Satisfaction
  • Prospective Studies
  • Quality of Life
  • Sacrococcygeal Region
  • Spinal Fusion / adverse effects*
  • Treatment Outcome
  • Young Adult