Instability of the coccyx in coccydynia

Journal of Bone and Joint Surgery [Br] 2000;82-B:1038-41

Jean-Yves Maigne, MD,* Denis Lagauche, MD,* Levon Doursounian, MD**

*Department of Physical Medicine, Hôtel-Dieu University Hospital, Place du Parvis Notre-Dame, F-75004, Paris, France

**Department of Orthopaedic Surgery, Boucicaut University Hospital, 78 rue de la Convention, F-75015, Paris, France

Abstract

Coccygectomy is a controversial operation. Some authors have reported good results but others advise against this procedure. The criteria for selection are ill-defined. We describe a study to validate an objective criterion for patient selection, namely radiological instability of the coccyx as judged by intermittent subluxation or hypermobility seen on lateral dynamic radiographs when sitting.

We enrolled prospectively 37 patients with chronic pain because of coccygeal instability unrelieved by conservative treatment who were not involved in litigation. The operation was performed by the same surgeon. Patients were followed up for a minimum of two years after coccygectomy, with independent assessment at two years. There were 23 excellent, 11 good, and 3 poor results. The mean time to definitive improvement was 4 to 8 months. Coccygectomy gave good results in this group of patients.

Extract from the paper, about operative technique:

The unstable part of the coccyx was excised under general anesthesia. A mid-line skin incision was made in the natal cleft 6 cm long, finishing 4 cm from the anus. The incision was carried down to the posterior surface of the coccyx, using electrocautery, keeping close to the bone. In order to expose the anterior surface safely, without damaging the rectum, the dissection was carried through the abnormal disc space, releasing the soft tissues a little at a time, allowing safe removal of the distal mobile segment. If the residual part of the coccyx was excessively prominent, it was trimmed using a rongeur [a surgical instrument for nipping away bone a little at a time]. The incision was closed in three layers, over a suction drain. The dressing was applied in order to separate the surgical scar from the anal margin. The drain was removed on the second day after operation.

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