Tailbone: Is partial coccygectomy the way to go?

Abstract

Background: Complete coccygectomy has proved to be a successful operation, with a success ratio of 70%–85%. Wound infection and dehiscence following coccygectomy ranges between 15% and 30%. The purpose of this article was to present improved outcomes following partial coccygectomy and to suggest modifications to mitigate wound complications. Methods: Seventeen patients (13 women and 4 men) underwent partial coccygectomy using a curved paramedian incision after failing nonoperative care for minimum of 6 months over the last 8 years. Twelve of these were posttraumatic, whereas five were of idiopathic origin. Patients were barred from sitting or sleeping supine for 2 weeks following the surgery. The use of water for cleaning post-defecation was also prohibited. Visual analog scale (VAS), Oswestry Disability Index (ODI), along with a novel Coccyx Disability Questionnaire (CDQ) as well as a truncated ODI (Coccyx Disability Index – CDI) were administered preoperatively, at 6 months and then at last follow-up. Wilcoxon signed rank tests were used as variables were nonparametric. Results: Fifteen patients completed questionnaires at a mean follow-up period of 68 months. Fourteen (93.33%) patients had good-to-excellent outcomes. VAS sitting improved from 9.27 to 0.79 (P = 0.001) and ODI improved from 68.89 to 8.27 (P = 0.001) postoperatively. Novel CDQ scores improved from 7.33 to 1.12 (P = 0.001) and CDI scores improved from 84.56 to 6.44 (P = 0.001). We compared outcomes of our partial coccygectomy cohort with those of complete or partial coccygectomy in literature, and found equivalent or superior results. Three (20%) of our patients developed wound infections, with only one (6.67%) requiring revision surgery, while the other two recovered with dressings. Conclusion: Partial coccygectomy provides equivalent or superior outcomes, compared to complete coccygectomy. Postoperative modifications for 2 weeks help mitigate wound complications. The proposed novel CDQ can be used by surgeons across the globe, once validated.