Sit-Stand Coccyx / Tailbone X-rays After Coccygectomy?

I was recently asked: Do I order sitting-versus-standing coccyx x-rays for patients who have persistent pain after coccygectomy (surgical removal of the coccyx/tailbone).


1) First of all, do we know for sure whether the ENTIRE tailbone has indeed been surgically removed?

  • If we know for sure that the entire tailbone has been surgically removed, then it may not be medically necessary to get x-rays done while sitting, since there is no remaining coccyx that could be hyper-mobile (essentially,  there’s no possibility of coccygeal dynamic instability if there is no coccyx to begin with).
  • If we do NOT know for sure whether the entire tailbone has been surgically removed (in many cases there is a partial coccygectomy performed, leaving the upper coccyx segment in place) then the remaining coccyx segment might be hyper-mobile (there might be dynamic instability of the remaining coccyx segment).
  • (Click here for an explanation about complete versus partial coccygectomy)

2) Secondly, if NO imaging studies have been done since the time of coccygectomy surgery, despite pain that has persisted for longer than expected after this surgery, then it usually make sense to start with the plain set of coccyx x-rays.

  • (Since it is possible that there may be a remaining coccygeal segment, you could get the sitting-versus-standing coccyx x-rays done at the same time, but if the local radiology center is not familiar with doing these then you can just start with plain x-rays specifically at the sacrum/coccyx region, including the AP [front-to-back] view and the lateral [side] view.)

3) Thirdly, aside from coccyx x-rays (radiographs), other diagnostic imaging studies of the sacrum/coccyx region in select cases might include: 

  • MRI ,
  • CT scans,
  • and sometimes triple-phase bone scans.
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