Dear Editor,

We thank Dr. Foye for his interest in our paper on the presenting features of chordomas of the sacrum and coccyx [1]. He is quite right to say that cauda equina symptoms only occur if the tumour has compressed the sacral nerve roots and that, otherwise, non-specific symptoms of coccydynia or back pain predominate. It has to be remembered that chordoma is an extremely rare condition relative to coccydynia from other causes; however, our patients experience similar problems with delays in diagnosis. It is our opinion that persistent coccydynia with or without neurological symptoms requires further investigations, including imaging studies, especially given the potential for treatments for coccydynia.