Definition and Overview

Coccygectomy is the partial or complete surgical removal of the coccyx or the tailbone, which is located near the rectum and connected to the sacrum, or the triangular bone that makes up the base of the spine.

This procedure is considered rare and is often the last resort for patients who do not respond to non-surgical therapies. The chances of experiencing post-operative pain and enduring a very long recovery period that can last for months to a year are the common reasons why many surgeons are apprehensive to even recommend the procedure. Nevertheless, as long as the surgeon is experienced and the patient is otherwise healthy, coccygectomy is known to produce very positive outcomes.

Who Should Undergo and Expected Results

Tailbone removal is done as the last-ditch effort to relieve pain in the lower back, especially the coccyx. This pain can be caused by:

  • The growth of a rare type of tumor called sacrococcygeal teratoma (SCT), which is more commonly diagnosed among newborns
  • Traumatic injuries such as a serious fall or a vehicular accident
  • An infection that has occurred or spread to the sacrum and the coccyx
  • Stress on the lower back caused by lifting heavy objects, among others
    Patients with lower back pain that involves the coccyx are often advised to try non-surgical therapies like massages, medications such as antibiotics, spinal manipulation, rest, compress therapy, and change of lifestyle before a coccygectomy is even considered. These may be done for a few months, after which the outcomes are evaluated. If the pain does not improve, surgical interventions are explored.

As long as the patient is in good condition and the surgeon is highly experienced in this type of procedure, the success rate can be as high as 80%. However, removing a part or the entire coccyx does not mean that spinal or back pain will no longer recur in the future.

How Does the Procedure Work?

Coccygectomy or tailbone removal is a quick procedure that can be completed in less than an hour and on an outpatient basis, although it is best performed in a hospital. The patient, while lying prone and with the lower back near the anus is exposed, is administered with general anaesthesia.

Using a scalpel, the surgeon makes an incision directly in the skin where the tailbone is located, going through the subcutaneous tissue and the periosteum, or the connective tissue that surrounds the bone. With precision, the surgeon begins to cut away the tailbone from back to front, making sure that no other tissues are involved. Once the procedure is done, the incision is sutured.

The removed tailbone may be sent to a lab for a biopsy to check for the presence of cancerous cells.

Complications and Risks

Pain remains to be one of the most common complications of the tailbone removal procedure, and it may begin right after surgery and last for a few months to a year. In some cases, the pain doesn’t disappear at all, and other follow-up surgeries or treatments are considered. Also, while the surgical wound is still healing and the pain persists, the patient may have trouble walking, sleeping, and sitting.

Aside from pain, an infection can also occur not only because of the surgical site but also because of the possibility that some tissue that is part of the rectum is cut or touched, giving pathogens and contaminants more space to get in. Other studies have also shown that adult patients may develop hernia, wherein parts of the pelvis bulge downward and out of the pelvic floor.

References:

  • Balain B, Eisenstein SM, Alo GO, Darby AJ, Cassar-Pullicino VN, Roberts SE, et al. Coccygectomy for coccydynia: caseseries and review of literature. Spine. 2006;31:E414–E420.

  • Bayne O, Bateman JE, Cameron HU. The influence of etiology on the results of coccygectomy. Clin Orthop Relat Res. 1984;(190):266–272

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