Abstract
PurposeWe aim to critically review the effectiveness and safety of coccygectomy with special regard to long-term outcomes.MethodsCoccygectomy 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.ResultsNineteen 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.ConclusionsCoccygectomy 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 evidenceIV
Highlights
The definition of coccygodynia is discomfort or pain in the lowest part of the spine, the coccyx
If the remaining patients do not respond to these treatment protocols, coccygectomy has to be considered as the therapeutical option
We want to show that coccygectomy is a safe treatment option in the long term for patients suffering from post-traumatic and hypermobility related coccygodynia resistant to conservative treatment for 6 months
Summary
The definition of coccygodynia is discomfort or pain in the lowest part of the spine, the coccyx. The condition was first defined by Simpson in 1958 [1] and is mainly triggered by direct trauma [2, 3]; indirect injuries; and the summation of micro-injuries [4] or by abnormal mobility of the tailbone. If the etiology of coccygodynia is not post-traumatic or mobility related it is called idiopathic. The first line of treatment consists of conservative treatment options such as non-steroidal anti-inflammatory drugs, sitting aids, physiotherapy, manual treatments such as joint mobilisation, or the repetitive injection of corticosteroids. Up to 85% of patients respond to these treatments and heal [9]. If the remaining patients do not respond to these treatment protocols, coccygectomy has to be considered as the therapeutical option
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