Instability of the coccyx in coccydynia

Abstract

Coccygectomy is a controversial operation. Some authors have reported good results, but others advise against the procedure. The criteria for selection are ill-defined. We describe a study to validate an objective criterion for patient selection, namely radiological instability of the coccyx as judged by intermittent subluxation or hypermobility seen on lateral dynamic radiographs when sitting.We enrolled prospectively 37 patients with chronic pain because of coccygeal instability unrelieved by conservative treatment who were not involved in litigation. The operation was performed by the same surgeon. Patients were followed up for a minimum of two years after coccygectomy, with independent assessment at two years. There were 23 excellent, 11 good and three poor results. The mean time to definitive improvement was four to eight months. Coccygectomy gave good results in this group of patients.

Acute traumatic instability of the coccyx: results in 28 consecutive coccygectomies

“…Our study only considered post-traumatic patients, with coccygeal fractures-dislocations due to direct trauma. Preoperative tests, including MRI and dynamic radiograms [9], showed an increase of the sacro-coccygeal angle of more than 25°. Our series therefore consisted in posttraumatic coccygeal lesions, with true instability.…”

“…From January 2001 to December 2010, we observed 53 consecutive patients affected by acute coccygodynia, with pain duration of less than 30 days [9]. Of these patients, 31 individuals had clearly sustained direct trauma.…”

“…A VAS pain assessment was performed, with seven patients reporting a ten points VAS pain, whilst remaining 21 showed scores ranging from 5 to 9 (mean 6.8 ± 2.0 SD). Sitting radiograms, according to Maigne [4,9], helped identifying 18 type I anterior instabilities (60 %) and 13 type II posterior instabilities (40 %). According to Postacchini and Massobrio classification [12], most individuals showed a type III coccyx, whereas four patients had a type II and two patients had type I.…”

“…Several authors [2,[6][7][8] report good results after coccygectomy in patients with posttraumatic or idiopathic coccygodynia. Patient selection by means of radiographical and psychological assessment may help in optimizing results [9].…”

“…Nevertheless, many surgeons prefer Gardner's technique [11], and no general consensus is given on treatment options. Another issue takes into account the extent of the excision, with many authors reporting similar results with total and partial coccygectomy [7,9,12], whereas others [3,13] claim total coccyx resection to be the best surgical choice.…”