Complete Coccygectomy versus Partial Coccygectomy

What is coccygectomy?
  • Coccygectomy is the surgical amputation of the coccyx.
  • During coccygectomy, the coccyx (tailbone) is removed.
Who needs coccygectomy?
  • Coccygectomy is only medically necessary in a relatively small fraction of patients with coccydynia (tailbone pain, coccyx pain).
  • Typically, coccygectomy is reserved for those patients who have failed to get adequate relief despite a full course of nonsurgical treatment (including using coccyx-wedge cushions, avoiding exacerbating factors, various coccyx injections, etc.).
Complete versus partial coccygectomy:
  • Coccygectomy can be “complete” or “partial”.
  • “Complete” coccygectomy involves removal of the ENTIRE tailbone.
  • “Partial” coccygectomy involves removal of only part of the coccyx, leaving the upper coccyx in place.
Deciding between complete versus partial coccygectomy:
  • In the small percentage of patients with tailbone pain who require coccygectomy, the decision regarding whether to do a complete versus incomplete/partial coccygectomy depends upon the surgeon during the procedure. It should also depend upon the specific anatomical/musculoskeletal cause of the tailbone pain. For example, if the pain is primarily coming from the highest joint within the coccyx (up at the sacrococcygeal joint [SCJ], where the lower part of the sacrum articulates with the upper part of the coccyx), than a partial coccygectomy would still leave the problematic source of pain still in place (which would obviously be undesirable.
  • Sometimes after a complete coccygectomy the surgeon may also “shave down” the lower part of the sacrum. This may be done to “smooth out” any pointy or irregular surfaces that might cause pain when used it upon them. This may also be done in hopes that surgical involvement of the lower sacral bone may help to stimulate healing at the surgical site.
  • One small study of 22 patients in Turkey showed that regardless of whether the coccygectomy was complete or partial, the outcomes were about the same (78% of patients obtained good or excellent relief). (Source: Unfortunately, this study did not specify exactly where in each patient’s coccyx was the abnormality or source of pain, so we do not know whether complete coccygectomy would have been more helpful in patients whose tailbone problem came from the upper coccyx.
Possible complications (side effects) of coccygectomy:

Reasons why we do not remove the coccyx in everyone who has coccyx pain:

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