Coccygectomy for coccygodynia: a cohort study with a long-term follow-up of up to 29 years

Abstract

Purpose We aim to critically review the effectiveness and safety of coccygectomy with special regard to long-term outcomes. Methods Coccygectomy was performed in our clinic in 38 patients between 1990 and 2019. All these patients (32 females vs. 6 males) have failed to respond to conservative treatment for at least 6 months prior to surgery. All patients were available for follow-up after mean 12,3 years (2 months to 29 years, 11 patients had a minimum FUP of 24 years). We evaluated all patients clinically and radiologically. Results Nineteen patients reported traumatic and 17 patients reported idiopathic onset of their symptoms; one patient had clinical symptoms after childbirth and another patient had coccygodynia after extensive low back surgery. 36 of our 38 patients were free of pain at least 6 months after surgery and had good or excellent clinical results according to the VAS which improved from 6.37 (SD 1.08) preoperatively to 0.68 (SD 0.99) at the recent follow-up. Two patients showed an ODI > 22 at the recent follow-up (24 and 28) and 32 had an ODI equal or under 4. There was no statistical significant difference in terms of clinical outcome between the different radiological types of the coccyx. Postoperative complications were rare: 1 superficial infection and one re-operation 6 months after initial surgery due to an pre-existing exostosis which had not been removed at the index surgery; no neurological complications and no major bleeding occurred. No patient had recurrent onset of coccygodynia. 37 out of 38 patients would have coccygectomy again. Conclusions Coccygectomy is a safe treatment option in patients with coccygodynia and shows excellent long-term results. We recommend to perform coccygectomy if patients fail to respond to conservative treatment for 6 months. Level of evidence IV

Coccygectomy for coccygodynia: A single-center experience

“…Similarly, previous studies have reported that a greater number of women were found to suffer from coccygodynia as compared to men. [3,20,21] Furthermore, direct or indirect trauma was found to be the common etiology of coccydynia in cohorts, which is in line with previous studies. [5,21] However, a few studies have reported a slightly higher percentage of idiopathy.…”

“…[40] Coccygectomy is opted for treating coccygodynia when conservation methods and therapies fail to bring relief and treat the condition. [20,37,46] However, due to the rarity of the condition and complications associated with the surgical treatment, operations are usually delayed. Hence, the aim of the study was to analyze the outcome of coccygectomy among patients with coccygodynia.…”

“…Similarly, it was found that 36 out of 38 of the patients reported excellent results after coccygectomy. [20] Furthermore, a satisfactory outcome was observed in 79% of the patients who underwent coccygectomy. [56] A review of 24 studies showed that out of 702 patients, excellent or good outcomes were observed in 83% of the patients.…”

“…[1,3] Initially, conservative management is carried out by prescribing analgesic and anti-inflammatory drugs, and in severe cases, steroid injections are utilized or surgical treatment if issues persist. [19,20]…”

“…[15,20,21] The surgical procedure involves the removal of the coccyx, either partially or completely, and it is only recommended for patients with anatomic defects, failed conservative therapy, or significant disability. [3,15,20] Current literature has reported the success of coccygectomy in several cases of persistent coccygodynia. [3,11,22] Wound infection is stated to be one of the most common complications.…”