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Coccygectomy Surgery for Pain
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
Every orthopedic surgeon
may take a slightly different approach to this 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:
1. 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.
2. 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.
3. The coccyx is then removed. It may be biopsied to
determine 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:
1.
Pre-operative patient selection
2. 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.
Potential Risks and Complications of
Coccyx Surgery
The main risk with this surgery involves the surgeon
accidentally moving out of the sub-periosteal 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.
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