Losing weight made the coccyx more painful

Anonymous

Original posting, 2003-11-02:

I am a 30-year-old female. When I was 18, I broke my tailbone skiing (I landed on a tree stump right on the coccyx). It was incredibly painful, but my local emergency room said there was nothing to be done for it and sent me home.

I have lived with the pain for some time now. In the beginning it was quite bad, and then I adapted my life around it. I sat on one hip in movie theaters, shifted quite a bit during college classes, and then, once a professional, got up from my chair frequently to walk around and relieve the pressure.

About six months ago, due to the stress of being an attorney, I lost approximately twenty pounds (I was 5'6 and 128 pounds before that). I don't know if I re-injured the coccyx somehow or if it was a result of being more exposed, but my tailbone began hurting more than ever before. I now cannot lie flat on my back on a table or even in bed, but have to shift position or sleep on my side. Even simple things like going to the dentist, driving, getting a facial, etc. have become impossible. Add the Porsche Boxster as a car that is not good for a painful coccyx. Worst of all, the tailbone is clearly visible through my skin, and even through light weight pants. It has been so since my accident 12 years ago.

I saw an orthopedic surgeon, who gave me lidocaine/steroid injections twice over a period of three months. These injections did not help; in fact, they seemed to make the pain worse. After an MRI, I am contemplating taking the doctor's suggestion and having the coccyx removed, along with the S-4 and pieces of the S-5. The surgeon has warned me about the horrors of injury to the dural sac and the potential of permanent incontinence if anything went wrong. [Note from Jon Miles - among hundreds of coccygectomies reported in the medical literature, permanent incontinence is not reported as a result of the surgery in any cases.] He says that the coccyx is clearly bent at a strange angle, protruding and abnormally long.

I haven't scheduled the surgery yet -- trying to find a time this year (my deductible has been paid, so I'd like to get it done by the end of 2003) when I can afford to recover for three weeks. I am using surgeons at Cedars-Sinai Medical Center in Los Angeles.

Update, 2003-12-14:

After having months of no communication about my surgery from my chosen surgeon, I chose to see Dr. Covarrubias in Mission Viejo [note unfortunately as of June 2005, Dr Covarrubias has retired. See list of doctors and specialists in the USA]. Even though Dr. Covarrubias is over an hour away from my home in Los Angeles, I have scheduled my surgery with him on December 17, 2003. He listened to my questions and saw immediately what the problem was on my MRI. (I've attached the MRI report, which is kind of cool). It's interesting because Dr. Covarrubias does the coccygectomy as an outpatient procedure that takes one hour, while my previous surgeon told me the operation would take two hours and that he would keep me in the hospital for two days(?) I don't think my previous surgeon had done many, if any, coccygectomies. Apparently Dr. Covarrubias has performed 100+.

I hope to take lots of before and after photographs to help us all understand what to expect in terms of scarring, etc. I'm looking forward to some relief from the pain!

MRI SCAN OF SACRAL AND COCCYGEAL BONES - WITHOUT CONTRAST:

INDICATIONS: 30-year-old female with tail bone injury twelve years ago with persistent pain.

TECHNICAL DATA: This scan was performed on the GE 1.5 Tesla Horizon LX magnetic resonance scanner. The following signal acquisition sequences were obtained:

  1. Sagittal: T1
  2. Coronal: T1
  3. Coronal: STIR T2
  4. Axial: T1
  5. Axial: Spin density with fat suppression

FINDINGS: No areas of abnormal signal are seen involving the sacrum or bilateral sacroiliac joints. There is decreased signal on Tl and STIR images within the soft tissues posterior to the coccygeal bone with an area of very low signal on Tl and STIR images. This most likely represents calcification in this area. This is most consistent with an old injury and soft tissue fibrosis.

There is increased signal seen on axial STIR images within the coccygeal bone with anterior subluxation of the distal coccygeal area, with no discrete cortical fractures seen throughout the coccygeal vertebral bodies. No evidence of a presacral mass is seen.

IMPRESSION:

Edema seen involving the distal coccygeal area with anterior subluxation of the two last vertebral bodies of the coccygeal bone, with surrounding fibrosis. This is most consistent with an old injury with soft tissue fibrosis, with repeated microtrabecular injury of the distal coccygeal area. There is also possible soft tissue calcification vs. prior surgery in this area. Please correlate clinically. No evidence of a mass is seen.

Update, 2004-02-22:

The surgery, while no walk in the park, was not as painful as I anticipated. In fact, the most painful part of the surgery was waking up in the recovery room on my back on a stretcher. I'm not quite sure why they placed me lying on my back, but as soon as I was cognizant and could go home with my father, I went home on my stomach and felt pain-free. We stopped for chai latte and a muffin on the way home and I had no pain whatsoever. The nursing staff gave me lots of Demerol to stop my body from shaking (I'm always cold, post-surgery) and the anesthesiologist had directly injected pain block into the surgical site, so I really did not feel pain for days 1 and 2.

Day three was when the pain began, but again, it wasn't horrific. I controlled it with prescription Vicoprofen and didn't even take all that much.

It's now been almost two months since the surgery. I'm driving, working, sitting without pain, flying on airplanes, etc. Without the coccyx sticking out, I have no more pain. Dr. Covarrubias did an amazing job with the incision, and it looks like nothing was ever there. I am thrilled with the results of the surgery and wish that I had removed my coccyx years ago.[see list of doctors and specialists in the USA].

Before surgery:

image

After surgery:

after surgery

later

healed

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