Surgical treatment of coccygodynia: an analytic review of the literature

Abstract

Coccygodynia is a pathological condition associated with pain-discomfort all around the bottom end of the spine. The aetiology and the intensity of the symptoms may defer significantly. The effectiveness of the surgical treatment remains obscure. Our purpose, through this systematic review is to evaluate the results of surgical treatment of coccygectomy. Literature retrieval was performed by the use of the PubMed searching engine utilising the terms 'coccygodynia-coccygectomy' in the English language from January 1980 to January 2010. Case reports and tumour related case series were excluded as well as articles published in other languages. In total 24 manuscripts were analyzed. Only 2 of them were prospective studies whereas 22 were retrospective case series; five were classified as Level III studies and the remaining as Level IV studies. In total, 671 patients with coccygodynia underwent coccygectomy following failed conservative management. The sex ratio, male/female was 1:4.4. The most popular aetiology for coccygodynia was direct trauma in 270 patients. 504 of the patients reported an excellent/ good outcome following the procedure. There were 9 deep and 47 superficial infections. Other complications included two haematomas, six delayed wound healings and nine wound dehiscence. The overall complication rate was 11%. Patients with history of spinal or rectal disorders, as well as idiopathic or with compensation issues, had less predictable outcome than those with history of trauma or childbirth. Coccygectomy can provide pain relief to as high as 85% of the cases. The most common reported complication was wound infection.

CT morphology and morphometry of the normal adult coccyx

“…When subject to pathology it can be a source of debilitating localized pain [2]. There is a remarkable paucity of data on the normal in vivo morphology and morphometry of the human adult coccyx.…”

“…Patients experience debilitating pain in the coccygeal region, exacerbated by sitting, standing, and/ or walking; women are four times more likely to be affected than men [2]. Most cases are considered to arise from sacrococcygeal or intercoccygeal joint instability, which is often traumatic in origin.…”

“…Most cases are considered to arise from sacrococcygeal or intercoccygeal joint instability, which is often traumatic in origin. Trauma may be acute from a fall or during childbirth, or chronic and repetitive, when obesity may be a predisposing factor [2,7]. Less common causes of coccydynia may be due to local bone or soft tissue pathology [8][9][10].…”

“…Less common causes of coccydynia may be due to local bone or soft tissue pathology [8][9][10]. However, one-third of cases are idiopathic [2,[9][10][11]. Some authors have suggested that individuals with a greater ventral angulation of the coccyx are more at risk of developing idiopathic coccydynia [3,12].…”

The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: a survey of the “medical” articles in the European Spine Journal, 2011

“…Surgery for coccygodynia is usually not considered a very effective operation. The article by Karadimas et al [19] may change this reputation. In their review, the authors were able to analyze 24 papers reporting results and complications of surgical resection of the coccyx.…”