Coccygectomy: surgery for coccyx pain

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Article reviewed and approved by Dr. Ibtissama Boukas, physician specializing in family medicine

La coccygectomy is thesurgical removal of all or part of the coccyx. It is an option for persistent pain who do not calm down with non-surgical treatment or activity modification. While the surgery itself is a relatively simple operation, recovery after the operation can be a long and uncomfortable process for the patient. In this article you will find all the details about the coccygectomy, its indication, the course of the procedure and the risks and complications.

What is a coccygectomy?

Le coccyx refers to three to five small, triangular-shaped bones that are found at the end of the spine just above the anus.

A coccygectomy is a surgical procedure in which part or all of the coccyx is removed. It is practiced in case of pain in the pelvic area following an injury.

To know everything about coccyx pain and their care, see the following article.

This procedure is rare and often comes into last resort for patients who do not respond to non-surgical therapies.

The intervention may lead to postoperative pain and require a very long recovery period (a few months to a year). It is for these reasons that surgeons are afraid to recommend the procedure.

In any case, with an experienced surgeon and a patient in good general conditions, the results of a coccygectomy are often satisfactory.

Indications for coccygectomy

THEcoccyx removal is the last resort for pain relief in the lower back, especially the tailbone. This pain can arise from various pathological reasons.

  • The growth of a rare type of tumor called sacrococcygeal teratoma often detected in newborns.
  • Traumatic injuries such as a serious fall or a traffic accident.
  • An infection that has occurred or spread to the sacrum and coccyx.
  • Pain on the lower back caused by lifting heavy objects, among other things.

In first intention, it is often advised to the patients suffering from lower back pain involving the coccyx to try non-surgical therapies before considering a coccygectomy. Examples include kinesitherapy (physiotherapy), medication, spinal manipulation and massage, rest, infiltrations, compresses or a change in lifestyle. Prefer these methods for several months before considering surgery.

 If the pain does not improve despite everything, then it is possible to consider a surgical intervention.

THEcoccyx operation is also indicated if pain in the pelvis persists due to local factors or factors from other parts of the body.

  • Injury (fracture, fracture-dislocation and childbirth).
  • Congenital malformations.
  • Degenerative disease (progressive damage to the coccyx due to aging or disease).
  • Psychosomatic (disease caused or aggravated by a mental factor such as stress).

Pain in structures near the coccyx may feel like a "referred pain which mimics coccydynia. They can be related to:

  • a lumbosacral injury (injuries in the lower part of the back);
  • tumors in the hip bone;
  • un narrow lumbar canal (abnormal narrowing of a passage through which the spinal cord);
  • a herniated disc or a vertebral disc rupture;
  • a painful degenerated disc;
  • a sacroiliac pain
  • pain in the sacro-coccygeal joint (the joint between the coccyx and the sacrum, this is the triangular bone in the lower back located between the two hip bones).

On the other hand, coccygectomy can be avoided in certain situations.

  • Absence of organic pathology (coccydynia in which there is no observable and measurable disease process such as inflammation or tissue damage).
  • Significant improvement with conservative treatment such as rest, painkillers, steroid injections, pillows, and physiotherapy.
  • Infection in neighboring areas.

As long as the patient is in good condition and the surgeon is experienced in this type of procedure, the success rate can reach 80%. However, removing part or all of the coccyx does not mean that spinal or back pain will not reoccur in the future.

How does the procedure work?

Usually these are the orthopedic or spinal surgeons who perform the coccygectomy. The intervention is done under General anaesthesia.

Tailbone removal is a quick procedure that is done in less than an hour and on an outpatient basis although it is best performed in a hospital.

Using a scalpel, the surgeon performs a incision directly into the skin above the coccyx. It passes through the subcutaneous tissue and the periosteum (the connective tissue that surrounds the bone). With precision, the surgeon begins to cut the coccyx from back to front, making sure that no other tissue is involved. Once the procedure is complete, the incision is sutured.

So what happens during a coccygectomy? Here are the details of each step.

Before surgery

Before surgery, your doctor may:

  • order blood tests and imaging (X-rays, computed tomography and magnetic resonance imaging);
  • learn about chronic health conditions;
  • explain the surgical procedure in detail including possible complications and answering your doubts and concerns related to the surgery;
  • ask for your written consent.

During surgery

  • The anesthesiologist will attach an intravenous line and administer anesthesia.
  • The surgeon will clean the skin with an antiseptic and make a surgical incision directly on the coccyx.
  • The coccyx is removed.
  • The protruding end of the sacrum (the bone to which the tailbone attaches) is smoothed.
  • The wound is closed with dissolvable stitches and covered with a dressing.

After the surgery

  • Your vital signs will be monitored and you may be able to get up and walk on the same day.
  • You can be discharged from the hospital within three to five days if there are no immediate complications.
  • The sutures are removed within two weeks.

The removed coccyx can be sent to a laboratory for a biopsy to verify the presence of cancer cells.

Complications and risks of a coccygectomy

After one coccygectomy, you may experience a decrease in pain and discomfort over several months. You can be followed for 12 to 36 months to assess clinical and functional results.

La pain remains one of the most common complications of coccyx removal. It can start right after surgery and last for a while.

In some cases, the pain does not go away at all and further surgeries or follow-up treatments are to be expected. Additionally, while the surgical wound is still healing and the pain persists, the patient may have difficulty walking, sleeping, and sitting.

The sitting position can be uncomfortable for several weeks after the operation. You can use a gel-filled cushion or you lean forward in a seated position for reduce discomfort.

You may find it comfortable to sleep on your side with a pillow between knees. Avoid wearing tight pants and sitting for a long time until fully recovered.

Following the coccygectomy, there may be complications such as:

  • an infection ;
  • a pain ;
  • swelling;
  • an injury to the rectum;
  • loss of bowel control;
  • nerve damage...

Besides the pain, a infection can also occur not only because of the surgical site, but of the possibility that certain tissues forming part of the rectum are cut or affected. This gives the Pathogens more space to enter.

Other studies have also shown that adult patients can develop a hernia, in which parts of the pelvis are bulged down and out of the pelvic floor.

Sources

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