Coccygectomy for coccydynia: case series and review of literature.
METHODS
This is a case series in which case notes review and telephone interview update were used to assess the outcome following coccygectomy.


OBJECTIVE
To correlate the clinical results of coccygectomy with histology and discography of the sacrococcygeal and intercoccygeal segments.


BACKGROUND
Clinicians regard chronic disabling pain in the sacrococcygeal region with much dismay because of the reputed unpredictability of the treatment outcome.


METHODS
A total of 38 patients had coccygectomy for intractable coccydynia, and 31 were available for follow-up. The excised specimen with intact sacrococcygeal joint was sent for histologic examination in 22 patients. There were 6 patients investigated using sacrococcygeal and intercoccygeal discography.


RESULTS
Mean postoperative follow-up was 6.75 years (range 2-16). There were 16 patients who benefited highly from the surgery, and 6 benefited to some extent, giving an overall beneficial result of 71%. Of all specimens, 86.3% had histologic changes of degeneration. Moderate-to-severe degenerate changes in sacrococcygeal and intercoccygeal joints on histology were found in 54.5% of patients. Of these patients, 83.3% did well with surgery. Only 57.1% of those patients with mild changes did well. There were 2 patients who had positive discography, and both did well with surgery. Three patients had negative diskographies, and 2 of them had a poor result, and 1 had only some relief.


CONCLUSIONS
It is possible that degenerate changes in sacrococcygeal discs and/or intercoccygeal discs are associated with pain. Surgical results are better in those with a severe degree of degenerative change. Coccygectomy remains a successful treatment for a majority of severely disabled patients with coccydynia.
Balain
Birender
B
Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom. balainb@yahoo.com
Eisenstein
S M
SM
Alo
G O
GO
Darby
Alan J
AJ
Cassar-Pullicino
V N
VN
Roberts
S E
SE
Jaffray
D C
DC
D000293:Adolescent; D000328:Adult; D000368:Aged; D003050:Coccyx / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D010146:Pain / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D011859:Radiography; D012447:Sacrum / Q000000981:diagnostic imaging / Q000601:surgery; D012720:Severity of Illness Index