Management of Coccydynia: A Prospective, Observational Study of Coccygectomy

Coccygodynia can be a functionally limiting and painful disease with conservative treatment providing mixed results. When proper surgical indications are met, results seem to be promising. However, there is a lack of data in the literature to support surgical treatment. The case series reports currently in the literature are small and retrospective with ill-defined selection criteria. To date there has been no study prospectively following patients undergoing coccygectomy. This type of study could accurately obtain data prospectively. This information will help better guide the clinician through treatment of this disease.

All patients will be seen and enrolled through an outpatient spine specialty clinic of the senior author. Patients that meet the inclusion criteria will be offered enrollment in the study by a third party (clinical research assistant). Patients enrolled will then complete pre-treatment SF-36, Oswestry Disability Scale and a pain visual analog scale. Patients will be followed at 2 weeks, 6 weeks, 3 months, 6 months, 1 year and 2 years after treatment. Patients will complete the questionnaire containing the VAS and tolerable sitting time at all visits with SF-36 and Oswestry disability scale completed at one year post treatment.

Inclusion criteria

• Pain in the region of the coccyx
• Pain for greater than 2 months
• Tenderness to palpation over coccyx
• Radiographic abnormalities of the coccyx

• Hypermobility of greater than 25 degrees, posterior subluxation of a mobile segment, or a coccygeal spicule on sitting radiographs
• post-traumatic coccygodynia
• Failure of conservative treatment methods: 4 weeks of NSAIDS, seat cushion, and rest
• Partial coccygectomy

Exclusion criteria

• Coexisting low back pain
• Total previous coccyx surgery or previous lumbar fashion
• Under 18 years of age