Partial or complete coccygectomy?

Coccygectomy is the surgical removal of part or all of the coccyx.

The coccyx is normally made up of two or three segments, with joints between them. The joints may be damaged, leaving the lower segment or segments only loosely attached. There is a difference of opinion among surgeons about whether it is better to remove all of the coccyx, or only those sections of it that are mobile.

For instance, Professor Doursounian says that he removes any loose segments, then tests to find out whether the remaining segment is mobile. If it is, he removes it, but if the remaining segment is firmly attached or fused to the sacrum, he leaves it.

On the other hand, Dr Lithwick removes all segments of the coccyx, and says that it is important to smooth down the sacrum where the coccyx was attached, as the sacrum will often have bony pieces left sticking out.

Some patients have told me that they had a partial coccygectomy, but still been in pain, and had a second operation to remove the remaining piece of coccyx (these were not patients of Professor Doursounian). Some of them, though not all, have had pain relief from the second operation. Dr Hellberg and Dr Strange-Vognsen reported similar findings, so advocated complete removal in all cases.

A trial was carried out by Ogur et al, An evaluation of two different methods of coccygectomy in patients with traumatic coccydynia. In this trial, 14 patients were given a partial coccygectomy, and 8 were given a full coccygectomy. No difference was found in the long-term outcome of the surgery. However, as there were only small numbers of patients in the trial, it is not conclusive.

Updated 2017-12-11

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