Note On A Case Of Coccygodynia; Removal Of The Coccyx; Recovery

The Lancet

1900 Vol. 155, No. 4007, p 1724-1725

Montague D. Makuna

As cases of coccygodynia are infrequent and the pathology and treatment of that disease are still sub judice, I might be permitted to record a case of complete recovery by the removal of the coccyx.

A lad, aged eight years, came under observation during the first week in March, 1900, suffering from severe pain over the sacral region which deprived him of sleep and from inability to assume a sitting posture. This was associated with loss of body-weight and anorexia.

On examination it was found that the coccyx was pointing backwards and downwards, its end touching a seat, so as to render a sitting position painful by the pressure of the soft parts and the skin between its point and the seat. On rectal examination it was discovered that the two lower segments of the sacrum were tilted inwards and that the continuity of the sacral curve was lost. This projection on the anterior surface of the sacrum could not be reduced under pressure, as what might be called the fractured surfaces were firmly but irregularly united. There was no clear history of injury and it is questionable whether this deformity in the sacrum was due to malformation or malnutrition. No operative procedure could be undertaken to reduce the deformity without doing considerable injury to the sacral nerves. While it was necessary that the coccyx should be removed to allow the lad to sit comfortably, I was in considerable doubt whether it would relieve him of his sufferings. He was kept in a recumbent position and lactophosphates and anodynes were administered for nine weeks without any improvement.

Under the circumstances I determined to remove the coccyx and, should this fail to relieve acute pain, to follow up the operation with treatment by osmic acid. On May l0th he was put under chloroform, the coccyx was pushed out through a straight incision in the median line, severed from the sacrum with a bone forceps, and, in order to prevent any damage being done to the diaphragm of the pelvis, dissected out from above downwards. There was no bleeding and the wound healed up rapidly under dry dressings. The patient is now able to sit comfortably, is free from pain, and is gaining flesh and vivacity.

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