For people who have persistent pain that is not alleviated or well-controlled with non-surgical treatment and activity modification, surgical removal of all or a portion of the coccyx (coccygectomy) is an option.
This surgery is rarely performed, and the procedure is not even included in most spine surgery textbooks. While the surgery itself is a relatively straight-forward operation, recovery from the surgery is a long and uncomfortable process for the patient.
Surgical Approach for Coccyx Pain
Different surgeons may take slightly different approaches to the operation. Perhaps the biggest difference between surgeons is that some remove only part of the coccyx, while others recommend removing the entire coccyx.
In general, the surgery involves the following steps:
- A one to two-inch incision is made right over the top of the coccyx, which is located directly under the skin and subcutaneous fat tissue. There are no muscles to dissect away.
- The covering over the bone (the periosteum) is then dissected away from the bone starting on the back and carried around the front. Staying in this plane of tissue is very safe, and allows the coccyx to be dissected free and then separated from the sacrum.
- The coccyx is then removed. It may be sent to pathology if there is any question as to whether or not it contains a tumor.
The operation takes about thirty minutes to perform and can be done on an outpatient basis. The most difficult part of the operation is that it takes a long time for the patient to heal. Generally, it takes three months to a year after the surgery before patients see any relief from their symptoms, and of course sitting is very difficult throughout the healing process.
Coccyx Surgery Success Rates
The reliability of the operation is largely dependent on two main factors:
- Pre-operative patient selection
- Experience of the surgeon, with an experienced surgeon operating on patients who are good candidates for the surgery.
If both of the above criteria are met, then an 80% to 90% success rate can be expected.
Although there has been little literature devoted to coccygectomy, in 1985 Wray et. al. reported in the British Journal of Bone and Joint Surgery that they had a 90% success rate for the procedure in 20 patients.
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Potential Risks and Complications of Coccyx Surgery
The main risk with this surgery involves the surgeon accidentally moving out of the subperiosteal plane around the bone during dissection. The rectum lies right in front of the coccyx, and if this is violated a severe infection could result. While it is unlikely, it is possible that if this were to happen, a diverting colostomy would be necessary to allow the rectum to heal.
Other potential risks include wound healing difficulties and/or local infection. Unlike most other spine surgeries, there are no significant nerve roots in the region that would be at risk.
Perhaps the biggest risk is continued pain in the coccyx post-operatively, meaning that the patient has to endure the long healing process and still has not had improvement in the symptoms.