Correspondence - Coccygodynia: Evaluation and Management

Journal of the American Academy of Orthopaedic Surgeons

Vol 12, No 4, July/August 2004, page 289

Norton H. Lithwick

norton@primus.ca

Toronto, Ontario Canada

To the Editor:

I was impressed with the thorough article about coccydynia [1]. The term coccydynia is far more descriptive and mellifluous than coccygodynia. One wonders why the "go" was added.

Also, many patients use donuts, which do not take pressure off the painful coccyx. A coccygectomy pillow with a large V cutout in the back is far more effective.

Finally and most importantly is the surgical procedure. In over thirty such operations, the key to successful surgery is removal of the sacral cornu. This involves removal of the terminal prominent 1 cm of the sacrum, rongeuring it to smoothness with the remaining sacrum. Leaving this terminal piece has resulted in reoperation in a few patients with success. In my opinion, persisting pain with failure of nonsurgical measures is an indication for surgery, with little consideration given to coccygeal mobility.

Norton H. Lithwick, BSc, MD Toronto, Ontario Canada

The Authors Reply:

The word coccygodynia is derived from a medieval Latin term, coccygeus, meaning "of the coccyx and odynia," thus "pain in the coccyx and surrounding area." Coccydynia is from New Latin and is a shortened form of coccygodynia. In our literature review, coccygodynia was more often the preferred term, so we elected to use it.

We agree that the coccygeal pillow with the large V cutout is more effective than the classic donut pillow. We also agree with the additional treatment during the surgical procedure. Smoothing or removing a portion of the sacral cornu will decrease the prominence of the remaining sacrum, particularly in a slender patient and in one with a more horizontal sacrum. Regarding coccygeal mobility, we believe that the dynamic radiographs of Maigne et al [2] have defined 70% of the symptomatic coccygeal patients who could benefit from surgical treatment. We agree that there are additional patients without abnormalities of coccygeal motion who may benefit from coccygectomy.

Guy R. Fogel, MD Paul Y. Cunningham III, MD Stephen I. Esses, MD Houston, Texas

References

[1] Fogel GR, Cunningham PY III, Esses SI: Coccygodynia: Evaluation and management. Journal of the American Academy of Orthopaedic Surgeons, 2004; 12:49-54.

[2] Maigne JY, Tamalet B: Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position: Clinical elements differentiating luxation, hypermobility, and normal mobility. Spine 1996; 21:2588-2593.

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