Coccygodynia review: coccygectomy case series

  • Waleed Mohammad Awwad
  • Munir Saadeddin
  • Jbreel Nasser AlsagerEmail author
  • Fahad Mohammad AlRashed
Original Article • SPINE - COCCYX



Coccygodynia is a pain of the coccyx that is typically exaggerated by pressure. Management includes anti-inflammatory medications, physiotherapy, and coccyx manipulation. Coccygectomy is the surgical approach for treating coccygodynia when the conservative management fails. Generally, coccygectomy yields good results. Its most common complication is wound infection.


To determine the effectiveness of coccygectomy in patients with coccygodynia.


A retrospective review of 70 patients (52 females and 18 males) with coccygodynia at King Khalid University Hospital in Riyadh was carried out, and the outcomes were studied. Twenty patients did not respond to conservative management; therefore, bimanual coccyx manipulation was done. Eleven were identified with instability and did not respond to coccygeal manipulation. Coccygectomy was performed on 8 patients while 3 declined.


All patients who underwent coccygectomy showed improvement of their symptoms. One case of superficial wound infection and delayed wound healing was encountered.


Coccygectomy provides effective pain relief to patients not responding to conservative therapies.


Coccygodynia Coccygectomy Manipulation Conservative treatment Coccyx pain 


Compliance with ethical standards

This research was approved by the institutional review board, college of Medicine, King Saud University.

Conflict of interest

The authors Waleed Mohammad Awwad, Munir Saadeddin, Jbreel Nasser Alsager, and Fahad Mohammad AlRashed declare that they have no conflict of interest.


  1. 1.
    Howard PD, Dolan AN, Falco AN, Holland BM, Wilkinson CF, Zink AM (2013) A comparison of conservative interventions and their effectiveness for coccydynia: a systematic review. J Man Manip Ther 21(4):213–219CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Kwon HD, Schrot RJ, Kerr EE, Kim KD (2012) Coccygodynia and coccygectomy. Korean J Spine 9(4):326–333CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Patel Ravi, Appannagari A, Whang PG (2008) Coccydynia. Curr Rev Musculoskelet Med 1:223–226CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Karadimas EJ, Trypsiannis G, Giannoudis PV (2011) Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J 20(5):698–705CrossRefPubMedGoogle Scholar
  5. 5.
    Nathan ST, Fisher BE, Roberts CS (2010) Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br 92(12):1622–1627. doi: 10.1302/0301-620X.92B12.25486 CrossRefPubMedGoogle Scholar
  6. 6.
    Postacchini F, Massobrio M (1983) Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg Am 65(8):1116–1124CrossRefPubMedGoogle Scholar
  7. 7.
    Maigne JY, Doursounian L, Chatellier G (2000) Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976) 25(23):3072–3079CrossRefGoogle Scholar
  8. 8.
    Maigne JY, Lagauche D, Doursounian L (2000) Instability of the coccyx in coccydynia. J Bone Joint Surg Br 82(7):1038–1041CrossRefPubMedGoogle Scholar
  9. 9.
    Ramieri A, Domenicucci M, Cellocco P, Miscusi M, Costanzo G (2013) Acute traumatic instability of the coccyx: results in 28 consecutive coccygectomies. Eur Spine J 22(Suppl 6):939–944. doi: 10.1007/s00586-013-3010-3 CrossRefPubMedCentralGoogle Scholar
  10. 10.
    Zeev Feldbrin MD, Menachem Singer MD, Ori Keynam MD, Valentine Rzetelny MD, David Hendel MD (2005) Coccygectomy for intractable coccygodynia. IMAJ 7:160–162PubMedGoogle Scholar
  11. 11.
    Cheng SW, Chen QY, Lin ZQ, Wang W, Zhang W, Kou DQ, Shen Y, Ying XZ, Cheng XJ, Lü CZ, Peng L (2011) Coccygectomy for stubborn coccydynia. Chin J Traumatol 14(1):25–28PubMedGoogle Scholar
  12. 12.
    Trollegaard AM, Aarby NS, Hellberg S (2010) Coccygectomy: an effective treatment option for chronic coccydynia—retrospective results in 41 consecutive patients. J Bone Joint Surg Br 92(2):242–245CrossRefPubMedGoogle Scholar
  13. 13.
    Doursounian L, Maigne JY, Faure F, Chatellier G (2004) Coccygectomy for instability of the coccyx. Int Orthop 28(3):176–179CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Mitra R, Cheung L, Perry P (2007) Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician 10:775–778PubMedGoogle Scholar
  15. 15.
    Datir A, Connell D (2010) CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol 65:21–25CrossRefPubMedGoogle Scholar
  16. 16.
    Khan SA, Kumar A, Varshney MK, Trikha V, Yadav CS (2008) Dextrose prolotherapy for recalcitrant coccygodynia. J Orthop Surg (Hong Kong) 16:27–29CrossRefGoogle Scholar
  17. 17.
    Bilgic S, Kurklu M, Yurttaş Y, Ozkan H, Oguz E, Şehirlioglu A (2010) Coccygectomy with or without periosteal resection. Int Orthop 34(4):537–541. doi: 10.1007/s00264-009-0805-2 CrossRefPubMedGoogle Scholar
  18. 18.
    Emerson SS, Speece AJ III (2012) Manipulation of the coccyx with anesthesia for the management of coccydynia. J Am Osteopath Assoc 112(12):805–807PubMedGoogle Scholar
  19. 19.
    Wray CC, Easom S, Hoskinson J (1991) Coccydynia: aetiology and treatment. J Pone Joint Surg Br 73(2):335–338Google Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Waleed Mohammad Awwad
    • 1
  • Munir Saadeddin
    • 1
  • Jbreel Nasser Alsager
    • 1
    Email author
  • Fahad Mohammad AlRashed
    • 1
  1. 1.Orthopedic Department, College of MedicineKing Saud UniversityRiyadhSaudi Arabia

Personalised recommendations