The Surgical Role in the Management of Persistent Coccygodynia in Adolescent and Pediatric Patients: A Retrospective Case Series.

Abstract

Background: Coccygodynia has been described as a disabling pain in the coccyx usually associated with sitting or with changing position from a sitting to a standing position. Pain may radiate to the sacrum, to the lumbar spine, or laterally to the buttocks. Treatment has rarely been studied in the adolescent population. Purposes/Questions: This study aimed to assess pain relief and satisfaction after partial or total coccygectomy in pediatric and adolescent patients suffering from coccygodynia that was resistant to conservative treatment. Methods: A retrospective, consecutive case series was performed to review the data from the hospital records of 29 patients who underwent partial or total coccygectomy from January 2016 to January 2020 in a university hospital setting. Patients suffered from coccygodynia resistant to conservative treatment. The study included 16 female (55%) and 13 male (45%) patients who ranged in age from 3 to 15 years. Patient records were assessed for postoperative complications, period of hospital stay, time to regain normal activity, postoperative pain improvement (using a 4-point Likert scale), and patients' or parents' satisfaction (using a 5-point questionnaire). Results: Total coccygectomy was performed in 19 patients and partial coccygectomy in 10 patients. Only 1 patient had a superficial infection after surgery. The length of hospital stay was 1.44 ± 0.97 days. Time to regain normal activity was 24.68 ± 4.32 days. Pain relief was excellent (complete pain relief) in 23 cases (79.3%) and good (relief of most pain but mild discomfort after prolonged sitting) in 6 cases (20.7%). There were no reports of fair (minimal or no pain relief) or poor (pain worse than before surgery) pain relief. In terms of patient or parent satisfaction, no one reported being "absolutely dissatisfied," 1 person was "dissatisfied" (3.4%), 3 people were "neither dissatisfied nor satisfied" (10.4%), 9 were "satisfied" (31%), and 16 were "absolutely satisfied" (55.2%). Conclusion: This case series suggests that coccygectomy may be a feasible management option for pediatric and adolescent patients, with favorable outcomes including pain relief, patient or parent satisfaction, and early return to activity.