Elsevier

Injury

Volume 38, Issue 10, October 2007, Pages 1183-1188
Injury

Coccygectomy for coccygodynia: Do we really have to wait?

https://doi.org/10.1016/j.injury.2007.01.022Get rights and content

Summary

Aim

To determine the results of 21 cases of persistent coccygodynia unresponsive to conservative management and treated with coccygectomy.

Methods

Of 81 patients with coccygodynia, 21 underwent surgical excision of the coccyx with a minimum 5 days of antibiotic prophylaxis. All 21 patients were followed for at least 2 years and questioned about their satisfaction with the operation and its timing. Pain levels were recorded preoperatively and during the postoperative period using the VAS scale.

Results

The mean VAS score was 51.88 (40–70), and this decreased to 3.17, 2.94 and 2.76 in the 6th, 12th and 24th months, respectively. This change was statistically significant. Of the 21 cases, 17 had an excellent result and 4 had a good result. None had a wound healing problem or infection. All were satisfied with the operation, and all stated that they would have liked to have undergone it sooner.

Conclusion

For unstable coccygeal fracture and persistent coccygodynia, coccygectomy is a reliable method of treatment with a high satisfaction and a low complication rate.

Introduction

Coccygodynia is a potentially debilitating complication following acute or cumulative trauma to the coccyx. There is not much information in the literature regarding the management of this syndrome. The majority of these patients are treated conservatively, and most orthopaedic surgeons resist operating on refractory cases because of possible wound problems and a false expectation of patient dissatisfaction.

The pain in the coccygeal region is named coccydynia or coccygodynia.4, 11 Although in most cases pain starts after a fall on the tailbone, other causes such as non-union of a coccygeal fracture, referred pain from a lower lumbar stenosis, disc herniation (Fig. 1) or degeneration, and sacrococcygeal joint degeneration, have also been reported.10 This pain can be quite debilitating and stressful, and may be worst while sitting.

The exact mechanism of coccygodynia is still unclear,2 but appropriate treatment requires elucidation of the cause.10 Treatment depends on the intensity of pain and the degree of impairment. The first line of treatment of coccygodynia following acute trauma comprises non-steroidal anti-inflammatory drugs, sitting aids and warm baths.2 In cases unresponsive to these conservative measures, injection of a local anaesthetic with steroids may be used. Addition of manipulation under general anaesthesia may further increase the success rate.11 In refractory cases, excision of the coccyx is reported to have good clinical results.11

In this study, we report the clinical outcomes of coccygectomy in 21 cases of coccygodynia due to an unhealed coccygeal fracture, which were unresponsive to the first and second lines of treatment.

Section snippets

Patients and methods

We examined the files of 97 patients at our university clinics, who were diagnosed with coccygodynia and/or coccygeal fracture; 16 of these were lost to follow-up and were excluded from the study. Of the remaining 81, 60 had responded to conservative treatment and were excluded from the study The remaining 21 had undergone surgical excision of the coccyx following both conservative treatment and three local steroid injections, and these formed the study population.

The average duration of

Results

The study involved a total of 21 patients. VAS scores with standard deviations are shown in Table 1.

The mean preoperative VAS score of 51.88 (40–70) decreased to a mean of 3.17 (excellent in 17 cases and good in 4 cases) at 6 months postoperatively. This change was statistically significant (p < 0.0001) (Table 2).

The VAS scores further decreased to a mean of 2.94 at 12 months postoperatively (there were again 17 excellent and 4 good results), but this decrease was not statistically significant (p =

Discussion

Coccydynia or coccygodynia is a pericoccygeal pain which notably increases during sitting.11 Frequently there is inflammation or dysfunction in the sacrococcygeal region.6, 9 Although coccydynia is commonly due to direct trauma to the tailbone, it can also result from the cumulative trauma of bad posture or a badly designed chair.8 In suspected cases with no history of significant trauma, it is not clear whether the pain is originating from the coccyx itself or radiating from a neighbouring

Conclusion

For people with an unstable coccyx and persistent coccgodynia unresponsive to conservative treatment, coccyectomy can be performed with a high success rate and low incidence of complications. The orthopaedic surgeon does not have to extend the duration of conservative treatment if she or he is certain about the diagnosis. Antibiotic prophylaxis should be extended to 5 days postoperatively to decrease the risk of infection.

Acknowledgement

We would like to thank the staff of Ankara University Ibni Sina Hospital Dept. of Orthopedics and Traumatology and Dr. Yusuf Unal (from Cukurova State Hospital) for their invaluable contributions regarding the collection of an excellently organised patient data.

References (11)

There are more references available in the full text version of this article.

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