Why is coccygectomy performed?
Although most cases of coccydynia are of unknown origin (idiopathic), cases requiring surgery are often caused by trauma to the coccyx that causes pain which can’t be resolved by more conservative approaches, like physical therapy, rest, oral pain relievers or corticosteroid injections. Other causes for coccygectomy include:
- degenerative conditions like arthritis
- congenital defects in the formation of the coccyx
- bone spurs forming near the end of the coccyx that cause soft tissue injury
- ongoing inflammation in the coccyx area
- significant instability of the coccyx
Sometimes, coccyx pain can occur when local structures are damaged or inflamed (referred pain), and prior to surgery, the doctor will perform a thorough evaluation to ensure pain is being caused by the coccyx and not surrounding tissues. Some of the causes of referred coccyx pain include:
- herniated or severely degenerated disc
- injuries to the portion of the spine just above the coccyx (the sacrum)
- inflammation in the joint between the coccyx and the sacrum
- tumors near the sacrum
How is coccygectomy performed?
Coccygectomy uses an incision directly over the coccyx so the surgeon can locate the tip of the bone. Incisions are made into the periosteum, a protective membrane that covers the bones. Once the periosteum has been released from the coccyx, the coccyx can be safely removed from the sacrum, the lower end of the spine that connects to the tailbone. In this approach, the periosteum, muscles and ligaments are left in place. A second surgical approach removes these structures along with the bone, but some studies have suggested this technique may increase the risk of infection following surgery. Following the procedure, the coccyx may be sent to pathology for evaluation if a tumor is suspected.
Procedures are usually performed by orthopedic or spine surgeons with experience in the procedure, and most patients remain hospitalized for about three days afterward. Although the procedure is fairly straightforward, as with any surgery, there is a risk for complications. In coccygectomy, the most common risks include wound infection (most of which are superficial) and delayed healing, sometimes with wound dehiscence (wounds opening up along incision lines).
What is recovery like?
Recovery from coccygectomy can be prolonged, sometimes taking from a few months to a year to find relief after surgery. The recovery process can be uncomfortable since pressure from sitting, lying down and even standing can cause inflammation that may delay healing. Antibiotics are usually prescribed for a few days to a week after the procedure to reduce the risk of infection, and followup may continue for a year or more to track progress and check for signs of infection.
Once recovery is complete, most coccygectomy patients report significant or complete pain relief, especially when their initial symptoms of coccyx pain were a result of trauma.
Will insurance cover the procedure?
Most insurance policies including government healthcare programs like Medicare will cover the costs of coccygectomy as long as a patient has one of the causes listed above and when conservative treatment measures like medications, use of cushions to relieve pressure on the coccyx, physical therapy and local and intradiscal injections have failed to provide symptom relief. When the cause of the coccyx pain cannot be determined by physical exam or diagnostic imaging like x-rays or magnetic resonance imaging (MRI), insurance coverage may be limited.