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Success rates for coccyx surgery (coccygectomy)

In trials, the long-term result of surgery to remove the coccyx was reported as 'good' or 'excellent' in 83% of cases.

There are at least three factors which could influence the likelihood of success:

1. Selection of patients. Success rates appear to be much higher if patients are carefully selected to be 'good candidates' for surgery:
   • Some doctors operate only on those with abnormal movement of the coccyx (see dynamic x-rays). This seems to be the most reliable indicator of success of the operation.
   • Some surgeons only operate on people with a history of injury (including injury caused by childbirth) to the coccyx.
   • Some will not operate unless corticosteroid injections have given some pain relief, even if it was only temporary.
2. Surgical procedure. Surgeons use similar techniques, with some variations - here are some examples:
   • Operative treatment of coccygodynia by Key, 1937 (PDF).
   • An improved technic of coccygectomy by Gardner, 1972.
   • Coccygectomy for instability of the coccyx by Doursounian, Maigne, Faure and Chatellier, 2004.
   • Coccygectomy for stubborn coccydynia by Cheng, Chen, Lin, Wang, Zhang, Kou, Shen, Ying, Cheng, Lu and Peng, 2011.
   • Prevention of post-coccygectomy infection in a series of 136 coccygectomies by Doursounian, Maigne, Cherrier and Pacanowski, 2011.
   • A surgeon's report on one operation
   • One patient wrote to me that she asked the surgeon to give her the coccyx after the operation, but he said he couldn't because he burred it out rather than cutting as one piece. His reasoning was to cause less trauma to the area, thus it should heal faster.
   • Some surgeons remove only the mobile part of the coccyx, and some all of it. Here are the arguments for partial or complete coccygectomy.
   • Post-operative infection can be a complication. Doursounian, Maigne, Cherrier and Pacanowski showed that use of a topical skin adhesive on the postoperative wound reduced infection rates from 14% to 3.6%. Additional use of antibiotics, a preoperative rectal enema, and closure of the incision in two layers reduced the rate of infection dropped to zero among 80 patients.
   • Some sew up the internal tissues with 'dissolvable' stiches before sewing up the skin, but others say that sewing the internal tissues is unnecessary, and could cause irritation or infection. [In my own experience, 'dissolvable' stitches did not dissolve, did cause irritation, and had to be removed by a nurse.]
   • A factor that could affect the the speed of recovery from the operation is pre-emptive analgesia.
3. Experience and skill of the surgeon.
   • Dr Maigne wrote: 'It is a difficult operation for the surgeon. The dissection of the bone has to be very careful and slow to avoid any damage which could compromise the result. With my colleague, Pr Doursounian, a Parisian orthopaedic surgeon, we have shown that there is a "learning curve" for this surgery, the results being better when the surgeon becomes more skilled and experienced.'
   • Removal of the coccyx is a very rare operation for most surgeons. Like other surgical procedures, it is best if you can get it carried out by a surgeon with experience in this particular operation. An indication of the importance of experience in surgery was a report in The Lancet (volume 354, 1999 November 13, pages 1697-1698) on a study of surgery for cleft lip and palate. The study found that surgeons who carried out 3 or more of these operations a year got much better results than those that did fewer of them. It made no difference if the surgeon was a consultant or trainee - experience in that particular operation made the difference.
   • Ask your surgeon how many coccygectomies he or she has carried out, and what the success rate was.

Updated 2022-07-24