European Spine Journal

, Volume 20, Issue 5, pp 698–705 | Cite as

Surgical treatment of coccygodynia: an analytic review of the literature

  • Efthimios J. KaradimasEmail author
  • Gregory Trypsiannis
  • Peter V. Giannoudis
Review Article


Coccygodynia is a pathological condition associated with pain–discomfort all around the bottom end of the spine. The aetiology and the intensity of the symptoms may defer significantly. The effectiveness of the surgical treatment remains obscure. Our purpose, through this systematic review is to evaluate the results of surgical treatment of coccygectomy. Literature retrieval was performed by the use of the PubMed searching engine utilising the terms ‘coccygodynia–coccygectomy’ in the English language from January 1980 to January 2010. Case reports and tumour related case series were excluded as well as articles published in other languages. In total 24 manuscripts were analyzed. Only 2 of them were prospective studies whereas 22 were retrospective case series; five were classified as Level III studies and the remaining as Level IV studies. In total, 671 patients with coccygodynia underwent coccygectomy following failed conservative management. The sex ratio, male/female was 1:4.4. The most popular aetiology for coccygodynia was direct trauma in 270 patients. 504 of the patients reported an excellent/good outcome following the procedure. There were 9 deep and 47 superficial infections. Other complications included two haematomas, six delayed wound healings and nine wound dehiscence. The overall complication rate was 11%. Patients with history of spinal or rectal disorders, as well as idiopathic or with compensation issues, had less predictable outcome than those with history of trauma or childbirth. Coccygectomy can provide pain relief to as high as 85% of the cases. The most common reported complication was wound infection.


Coccygodynia Coccygectomy Coccyx surgical treatment 



Mr. Nikolaos Kanakaris and Mrs. Despoina Kakagia made the appropriate corrections as linguistic personnel.

Conflict of interest

No funds were received in support of this study.


  1. 1.
    Simpson JY (1859) Coccygodynia and diseases and deformities of the coccyx. Med Times Gaz 40:1–7Google Scholar
  2. 2.
    Maigne JY, Doursounian L, Chatellier G (2000) Causes and mechanisms of common coccygodynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976) 25(23):3072–3079Google Scholar
  3. 3.
    Duncan GA (1937) A painful coccyx. Arc Surg 34:1088–1104Google Scholar
  4. 4.
    Wray CC, Easom S, Hoskinson J (1991) Coccydynia. Aetiology and treatment. J Bone Joint Surg Br 73(2):335–338PubMedGoogle Scholar
  5. 5.
    Bayne O, Bateman JE, Cameron HU (1984) The influence of etiology on the results of coccygectomy. Clin Orthop Relat Res 190:266–272PubMedGoogle Scholar
  6. 6.
    Pyper JB (1957) Excision of the coccyx for coccygodynia; a study of the results in twenty-eight cases. J Bone Joint Surg Br 39-B(4):733–737PubMedGoogle Scholar
  7. 7.
    Postacchini F, Massobrio M (1983) Idiopathic coccygodynia. J Bone Joint Surg Am 65:123–126Google Scholar
  8. 8.
    Maigne JY, Tamalet B (1996) Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position. Clinical elements differentiating luxation, hypermobility, and normal mobility. Spine (Phila Pa 1976) 21(22):2588–2593Google Scholar
  9. 9.
    Maigne JY, Guedj S, Straus C (1994) Idiopathic coccygodynia. Lateral roentgenograms in the sitting position and coccygeal discography. Spine (Phila Pa 1976) 19(8):930–934Google Scholar
  10. 10.
    Key JA (1937) Operative treatment of coccygodynia. J Bone Joint Surg Am 19:759–764Google Scholar
  11. 11.
    Gardner RC (1972) An improved technique of coccygectomy. Clin Orthop 85:143–145PubMedCrossRefGoogle Scholar
  12. 12.
    Bilgic S, Kurklu M, Yurttaş Y et al (2009) Coccygectomy with or without periosteal resection. Int Orthop 34(4):537–541PubMedCrossRefGoogle Scholar
  13. 13.
    Wray AR, Templeton J (1982) Coccygectomy. A review of thirty-seven cases. Ulster Med J 51(2):121–124PubMedGoogle Scholar
  14. 14.
    Eng JB, Rymaszewski L, Jepson K (1988) Coccygectomy. J R Coll Surg Edinb 33(4):202–203PubMedGoogle Scholar
  15. 15.
    Hellberg S, Strange-Vognsen HH (1990) Coccygodynia treated by resection of the coccyx. Acta Orthop Scand 61(5):463–465PubMedCrossRefGoogle Scholar
  16. 16.
    Grosso NP, van Dam BE (1995) Total coccygectomy for the relief of coccygodynia: a retrospective review. J Spinal Disord 8(4):328–330PubMedCrossRefGoogle Scholar
  17. 17.
    Zayer M (1996) Coccygodynia. Ulster Med J 65(1):58–60PubMedGoogle Scholar
  18. 18.
    Maigne JY, Lagauche D, Doursounian L (2000) Instability of the coccyx in coccygodynia. J Bone Joint Surg Br 82(7):1038–1041PubMedCrossRefGoogle Scholar
  19. 19.
    Perkins R, Schofferman J, Reynolds J (2003) Coccygectomy for severe refractory sacrococcygeal joint pain. J Spinal Disord Tech 16(1):100–103PubMedCrossRefGoogle Scholar
  20. 20.
    Ramsey ML, Toohey JS, Neidre A et al (2003) Coccygodynia: treatment. Orthopedics 26(4):403–405PubMedGoogle Scholar
  21. 21.
    Doursounian L, Maigne JY, Faure F et al (2004) Coccygectomy for instability of the coccyx. Int Orthop 28(3):176–179PubMedCrossRefGoogle Scholar
  22. 22.
    Hodges SD, Eck JC, Humphreys SC (2004) A treatment and outcomes analysis of patients with coccydynia. Spine J 4(2):138–140PubMedCrossRefGoogle Scholar
  23. 23.
    Wood KB, Mehbod AA (2004) Operative treatment for coccygodynia. J Spinal Disord Tech 17(6):511–515PubMedCrossRefGoogle Scholar
  24. 24.
    Karalezli K, Iltar S, Irgit K et al (2004) Coccygectomy in the treatment of coccygodynia. Acta Orthop Belg 70(6):583–585PubMedGoogle Scholar
  25. 25.
    Feldbrin Z, Singer M, Keynan O et al (2005) Coccygectomy for intractable coccygodynia. Isr Med Assoc J 7(3):160–162PubMedGoogle Scholar
  26. 26.
    Pennekamp PH, Kraft CN, Stütz A et al (2005) Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma 59(6):1414–1419PubMedCrossRefGoogle Scholar
  27. 27.
    Balain B, Eisenstein SM, Alo GO et al (2006) Coccygectomy for coccygodynia: case series and review of literature. Spine (Phila Pa 1976) 31(13):E414–E420Google Scholar
  28. 28.
    Mouhsine E, Garofalo R, Chevalley F et al (2006) Post-traumatic coccygeal instability. Spine J 6(5):544–549PubMedCrossRefGoogle Scholar
  29. 29.
    Capar B, Akpinar N, Kutluay E et al (2007) Coccygectomy in patients with coccygodynia. Acta Orthop Traumatol Turc 41(4):277–280PubMedGoogle Scholar
  30. 30.
    Sehirlioglu A, Ozturk C, Oguz E et al (2007) Coccygectomy in the surgical treatment of traumatic coccygodynia. Injury 38(2):182–187PubMedCrossRefGoogle Scholar
  31. 31.
    Cebesoy O, Guclu B, Kose KC et al (2007) Coccygectomy for coccygodynia: do we really have to wait? Injury 38(10):1183–1188PubMedCrossRefGoogle Scholar
  32. 32.
    Traub S, Glaser J, Manino B (2009) Coccygectomy for the treatment of therapy-resistant coccygodynia. J Surg Orthop Adv 18(3):147–149PubMedGoogle Scholar
  33. 33.
    Fairbank JCT, Couper J, Davies JB et al (1980) The Oswestry low back pain questionnaire. Physiotherapy 66:271–273PubMedGoogle Scholar
  34. 34.
    Fogel GR, Cunningham PY 3rd, Esses SI (2004) Coccygodynia: evaluation and management. J Am Acad Orthop Surg 12(1):49–54PubMedGoogle Scholar
  35. 35.
    García FJ, Franco JD, Márquez R et al (1998) Posterior hernia of the rectum after coccygectomy. Eur J Surg 164(10):793–794PubMedCrossRefGoogle Scholar
  36. 36.
    Kim NH, Suk KS (1999) Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Med J 49:215–220Google Scholar
  37. 37.
    Grassi R, Lombardi G, Reginelli A et al (2007) Coccygeal movement: assessment with dynamic MRI. Eur J Radiol 61(3):473–479PubMedCrossRefGoogle Scholar
  38. 38.
    Mazza L, Formento E, Fonda G (2004) Anorectal and perineal pain: new pathophysiological hypothesis. Tech Coloproctol 8(2):77–83PubMedCrossRefGoogle Scholar
  39. 39.
    Parks AG, Porter NH, Hardcastle J (1966) The syndrome of the descending perineum. Proc R Soc Med 59(6):477–482PubMedGoogle Scholar
  40. 40.
    Sinaki M, Merritt JL, Stillwell GK (1977) Tension myalgia of the pelvic floor. Mayo Clin Proc 52(11):717–722PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Efthimios J. Karadimas
    • 1
    • 3
    Email author
  • Gregory Trypsiannis
    • 2
  • Peter V. Giannoudis
    • 1
  1. 1.Academic Orthopaedic DepartmentLeeds General InfirmaryLeedsUK
  2. 2.Department of Medical StatisticsDemocritus University in ThraceAlexandroupolisGreece
  3. 3.AthensGreece

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