Spine (Philadelphia Pasadena Edition)
2006 Jun 1; 31(13): E414-20.
Balain B, Eisenstein SM, Alo GO, Darby AJ, Cassar-Pullicino VN, Roberts SE, Jaffray DC.
Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, United Kingdom.
STUDY DESIGN.: 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.
SUMMARY OF BACKGROUND DATA.: 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.