Operative treatment for coccygodynia

Few data exist comparing the surgical and nonsurgical treatment of coccygodynia. We sought to retrospectively review our experience with coccygectomy compared with injections for the relief of coccygodynia to determine rates of success and patient satisfaction and identify complications.

From March 1993 to January 2002, 51 consecutive patients with the diagnosis of coccygodynia were evaluated. All of the patients complained of pain while sitting and had localized pain to external and internal palpation of the coccyx on physical examination. Nonoperative treatment (medications, cushions, therapy) had failed to relieve the patients' symptoms. All patients were seen in follow-up for physical examination and completed a questionnaire by an independent examiner. Follow-up of the patients was 26 months (range 12-59 months). Follow-up data were available on 45 of the 51 enrolled. The patients were divided as follows: 20 patients were treated with total coccygectomy and 25 patients were treated with injection therapy.

Of those treated operatively, 18 patients (90%) felt improved and were satisfied with the procedure. Two patients felt their symptoms to be unchanged and were dissatisfied. Postoperative complications included seven wound problems: four superficial infections and three patients with persistent drainage. All resolved with local wound care and oral antibiotics. No further surgery was necessary. There were no bowel injuries and no reports of sphincter problems. Of those treated with injections, 5 of the 25 (20%) felt improvement and were satisfied. Sixteen (64%) were not improved, and four (16%) felt worse. Five (20%) eventually were treated with coccygectomy, four with satisfactory relief in symptoms.

Despite the potential for wound problems, coccygectomy for relief of coccygodynia can be a safe and effective treatment option with a high patient satisfaction rate. Wound closure and postoperative wound care are of utmost importance.