Coccydynia; excision of coccyx

The Lancet

1892, Vol. 140, No. 3610, p 1046.

Mr. Lucy

South Devon And East Cornwall Hospital, Plymouth.

There are many conditions for which it may be necessary to excise the coccyx, but we rarely meet with any of them in practice. The patients usually give a history of injury to the part, which on examination is found to have sustained fracture or displacement, or the injury may have led to a chronic inflammation of the bone or joint or to necrosis of the bone. The formation of a tumour or a congenital elongation of the bone may necessitate excision. There is also a group - of which the following is an example - in which after removal no abnormal change in the bone is found. It is difficult to diagnose these cases of coccydynia from hysterical or reflex cases. The condition is somewhat rare in men. Descriptions of the operation have been published in The Lancet from time to time. We may instance cases under the care of Mr. Whitehead (1) and Mr. Odell (2), and an interesting letter by Dr. Nott (3).

J. M, aged sixty-three, single, cook, was admitted on Feb. 4th, 1892, complaining of great pain in the lower part of the back when sitting down which had been present for over a year. A few years ago she slid off a table and hurt "the bottom of her spine" on a tiled floor. She had no pain on walking or on defecation. There was a small swelling the size of a marble to the right of the tip of the coccyx and presenting a small dimple on the surface. The coccyx was freely moveable forwards at the sacro-coccygeal joint, the movement causing the patient intense pain. She also had a slight anal fissure and an intcro-cxternal haemorrhoid. So, thinking that the neuralgic symptoms might be due to the latter, she was given chloroform on Feb. 12th, and the sphincter was stretched and the haemorrhoid removed by crushing. She quickly got well from this operation, but the severe pain on sitting persisted ; therefore, on Feb- 26th she was again anaesthetised. A longitudinal incision was made over the coccyx down to the bone, the periosteum was divided and separated by a raspatory and the coccyx removed. At its tip there was a small dermoid cyst containing sebaceous material, which was dissected out. Haemorrhage was pretty brisk from several small arteries in front of the coccyx. The wound healed by granulation, She got up on March 30th, the wound being quite sound, walked on April 9th, and left the hospital; on April 26th, being able to sit comfortably without any pain at ail- She was last section May 26th, three months after the operation, the wound was soundly healed, and she was back at her work, was quite free from pain on sitting down, and was putting on flesh.

1. Whitehead, W. Excision of the coccyx. The Lancet. 1886. Vol. 128, No. 3281, pp 112-113.

2. Odell, W. A case of removal of the coccyx. The Lancet, 1887, Vol. 129, No. 3326, p 1088.

3. Nott, JC. Extirpation of the coccyx. The Lancet 1870, Vol. 96, No. 2462, p 654.

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