During my orthopaedic training, I was told never to excise the coccyx as it seldom cured the patient; most of them were female and neurotic anyway. I saw at least one patient who had had pieces excised on 2 separate occasions and still not cured, and was in fact worse. This tended to reinforce my teachers' point of view.
Then I did 1 or 2 operations myself (because patients begged me to do something) and the patients were some of the most grateful I have ever treated. I have now done around 14. Most but not all have been female. I must admit 1 or 2 of them still seem a bit flaky. But all got some help from the procedure. None would say they were made worse.
It seems careful selection and counselling are the keys to a good result. You must avoid surgery in a patient with a complex medical history. I do usually advise steroid injection as a first measure. This can be done in outpatients but is not very pleasant! Can also be done under anaesthesia which gives an opportunity for a good manipulation. Injection works best if the symptoms have not been present for too long (<3 months). Less reliable if a long standing problem. The operation is NOT particularly difficult but experience does reduce the collateral damage to soft tissues and adjacent nerves. My patients seemed to recover in weeks rather than months.
I work in the UK near Windsor, Staines and Chertsey. I can put patients in touch with others treated by me.
Note - Mr Bloomfield treats patients privately, but is willing to give an opinion by email at: email@example.com.