What Happens During a Coccygectomy?

Generally, orthopedic or spinal surgeons perform the surgery. Coccygectomy is usually done under general anesthesia.

Coccygectomy is the surgical removal of the tailbone (coccyx). It is done in the cases of pain in the tailbone region (coccydynia) when conservative treatment options, such as rest, painkillers, physiotherapy, and steroid injections, have failed. 

The surgery is not commonly done, but it can be efficiently performed by experienced orthopedic or spinal surgeons. Many studies report good to excellent outcomes in pain relief after coccygectomy. 

The procedure may be performed as either a partial or complete coccygectomy. Partial coccygectomy, however, has a higher surgical failure than total coccygectomy, as reported by a few studies. 

Coccygectomy may be done when there is a stubborn pain in the tailbone due to local factors or factors from other parts of the body:

• Injury (fracture, fracture-dislocations, and childbirth)
• Birth defects
• Tumors
• Degenerative (progressive damage to the tailbone due to aging or disease)
• Psychosomatic (a disease caused or worsened by a mental factor such as stress)
• Unknown

Pain from the structures near the tailbone may be felt as a “referred pain” that mimics coccydynia. These factors are:

• Lumbosacral injuries (injuries in the lower part of the back)
• Tumors in the hip bone
• Lower lumbar spinal stenosis (abnormal narrowing of a passage through which the spinal cord passes) 
• Vertebral disc herniation/rupture or painful degenerated disc
• Pain from the sacrococcygeal joint (the joint between the coccyx and the sacrum, which is the triangular bone in the lower back situated between the two hip bones)

Coccygectomy may be avoided if there is:

• Absence of organic pathology (coccydynia in which there is no observable and measurable disease process, such as inflammation or tissue damage)
• Significant improvement with conservative treatment such as rest, pain killers, steroid injections, cushions, and physiotherapy
• Infection in nearby regions

Generally, orthopedic or spinal surgeons perform the surgery. Coccygectomy is usually done under general anesthesia (you sleep during the procedure). 

Before the surgery

Your doctor may:

• Order blood tests and imaging (X-ray, computed tomography scan, and magnetic resonance imaging)
• Ask you about chronic health conditions
• Ask you about any medications you are on
• Ask about any allergies you may have
• Explain the surgical procedure in detail, including possible complications and address your doubts and concerns related to the surgery
• Obtain your written consent
• Ask you to not eat anything for at least eight hours before the procedure

During the surgery:

• You will be asked to wear a hospital gown
• The anesthesiologist will attach an intravenous line and administer anesthesia
• The surgeon will clean the skin with antiseptic and make a surgical cut (incision) directly over the tailbone (coccyx)
• The coccyx is removed
• The prominent end of the sacrum (the bone to which the coccyx is attached) is smoothened
• The wound is closed with dissolvable stitches and covered with a dressing
• A small drain may be placed if needed

After the surgery:

• Your vital signs will be monitored in the recovery room 
• You will be weaned off the anesthesia and administered painkillers
• You may be able to get up and walk the same day
• You may be discharged from the hospital within three to five days if there are no immediate complications.
• Dressings are changed every three days
• Sutures are removed within two weeks 

After coccygectomy, you may experience relief from pain and discomfort in several months. You may be followed up for 12 to 36 months to assess clinical and functional outcomes. 

Sitting can be uncomfortable for many weeks after the operation. You may use a gel-filled cushion or lean forward while sitting to reduce the discomfort. 

You may find it comfortable to sleep on your side with a pillow between the knees. Avoid wearing tight pants and sitting for long until healing is completed.

Following coccygectomy, there may be some complications such as:

• Infection
• Pain
• Swelling
• Injury to the rectum
• Loss of bowel control
• Nerve damage