coccygectomy

Coccygectomy is a surgical procedure that involves removing all or part of the coccyx (tailbone) to treat chronic coccygodynia that has not responded to nonoperative treatments. The aim is to relieve localized pain and restore function in the lower back and pelvic region.

Indications for coccygectomy typically include persistent, severe coccygeal pain after an adequate trial of conservative management, often following an injury or repetitive strain. Before surgery, evaluation usually includes clinical examination, imaging studies, and sometimes diagnostic injections to confirm the coccygeal origin of pain. Contraindications include active infection, poor wound healing, or medical conditions that increase surgical risk and make expected benefit unlikely.

The procedure is most commonly performed through a posterior approach. An incision is made over the coccygeal region, and the coccyx is mobilized and removed in whole or in part, depending on the extent of disease and surgeon preference. Care is taken to avoid injury to surrounding structures and to achieve hemostasis. After removal, the wound is closed in layers, and postoperative care focuses on reducing pressure on the area to minimize complications.

Recovery and postoperative care involve pain management, stool softeners to prevent straining, meticulous wound care, and gradual return to activity. Patients are typically advised to avoid prolonged sitting during the initial healing period, with a gradual return to normal activities over several weeks to months. Some individuals may benefit from physical therapy.

Risks and potential complications include wound infection or dehiscence, hematoma, rectal or nerve injury, and persistent or recurrent pain. Outcomes are variable; many patients experience meaningful relief, while others have ongoing symptoms. Coccygectomy is generally reserved for carefully selected cases after failure of nonoperative measures.