Heterotopic Ossification of the Coccyx as a Post-operative Complication of Coccygectomy

Association of Academic Physiatrists Annual Meeting, 2011.

Proceedings, page 66

Lercher, Kirk, Foye, Patrick M.

Full paper (Poster)

Case Description:

Coccygectomy (removal of the coccyx) is a surgical procedure used to treat coccydynia (tailbone pain). This surgery has many potential post-operative complications including infection, pelvic prolapse, lengthy recovery process, persistent pain, etc. Literature review failed to demonstrate any reported cases of development of heterotopic ossification (ectopic bone) as a post-operative complication of coccygectomy. We present a 36 year-old male patient who fractured his coccyx when he fell from a dirt bike. An orthopedic surgeon performed a partial coccygectomy approximately 2 months after the initial injury. Following the surgery, unfortunately the pain in his tailbone region persisted, especially when sitting, though his pain while standing had decreased. He subsequently was treated by multiple specialists including physical therapists, chiropractors and a pain management physician who performed 3 coccyx steroid injections. Despite these interventions his coccydynia persisted for over five years before presenting for evaluation at our physiatric musculoskeletal practice at an academic medical center. Coned-down sacrum/coccyx x-rays were done, revealing heterotopic ossification distal to and posterior to the remaining coccygeal segment (Cl). Review of his pre-operative and post-operative images confirmed that the heterotopic ossification was a post-operative occurrence. Review of post-operative MRI and CT scans confirmed heterotopic ossification, which had been unappreciated at the time those images had been done and read. He was subsequently treated with ganglion Impar nerve block and steroid injection.

Discussion:

Heterotopic ossification of the coccyx has not been previously reported as a post-operative complication of coccygectomy in the treatment of coccydynia. However, this patient's history, physical exam and radiographic findings confirm the development of Heerotopic ossification of the coccyx following partial coccygectomy.

Conclusions:

Heterotopic ossification is a newly-reported post-operative complication of coccygectomy

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