Coccygectomy surgery for coccydynia (coccyx pain)

For people who have persistent pain that is not relieved or can not be controlled well with nonsurgical treatment and activity modification, surgical removal of all or part of the coccyx (coccygectomy) is an option.

This surgery is carried out very infrequently, and the procedure is not even included in most of the spine surgery textbooks. Although surgery itself is a relatively simple operation, recovery from surgery is a long and annoying process for the patient.

Surgical approach for coccyx pain

Each surgeon can approach the surgery in a slightly different way. Perhaps the biggest difference among surgeons is that some remove only part of the coccyx, while others recommend removal of the entire coccyx.

In general, surgery involves the following steps:

• An incision is made two to five centimeters just above the coccyx, which is directly under the skin and the subcutaneous fat tissue. There are no muscles to dissect.
• The covering of the bone (periosteum) is dissected away from the bone, starting from the back and until around the anterior part. Staying in this plane of tissue is very safe, and allows the coccyx to be dissected and then separated from the sacrum.
• Then the coccyx is removed. It can be sent to the department of pathological anatomy if there is any doubt about whether it contains a tumor or not.

The operation takes about thirty minutes and can be done on an outpatient basis. The most difficult part of the operation is that the patient takes a long time to heal. Usually, just three months or up to a year after surgery, the patient may feel some relief from their symptoms and, of course, sitting is very difficult during the whole healing process.

Success rates of coccyx surgery

The reliability of the operation depends to a large extent on two main factors:

• Preoperative patient preparation
• The experience of the surgeon, with an experienced surgeon who operates patients who are good candidates for surgery.

If both of the above criteria are met, then a success rate of 80% to 90% can be expected.

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

Possible risks and complications of coccyx surgery

The main risk of this surgery is that the surgeon accidentally moves out of the subperiosteal plane around the bone during the dissection. The rectum is just in front of the coccyx, and if it was injured could cause a serious infection. While it is unlikely, if this were to happen, a bypass colostomy would probably be necessary to allow the rectum to heal.

Other potential risks are the difficulties of wound healing or a local infection. Unlike most other spinal surgeries, there are no important nerve roots in the region that could be at risk.

Perhaps the greatest risk is that the pain in the coccyx continues after the operation, which means that the patient will have to endure the long healing process but there will be no improvement in the symptoms.