Coccygectomy

The coccyx commonly referred as “TAILBONE. “It is the last part of the vertebral column in human beings. It is basically triangular in shape that makes bottom (inferior) portion of the spine below the sacrum. Let’s get to know its importance, role, Issues related to it, what is Coccygectomy and what is the need of Coccygectomy.

INTRODUCTION

The coccyx is comprised of 3 to 5 coccygeal vertebrae either by fusion or separate. It is attached to the sacrum by a fibrocartilaginous joint which allows limited movement between the sacrum and the coccyx. It bears the weight of a person when a person is in sitting position. Coccygodynia (pain in the region of coccyx) mostly affects adults with a higher prevalence among women than men. Trauma is the most common cause of Coccygodynia. A fall onto one’s buttocks may cause a contusion, Fracture or Dislocation of Tailbone. Sitting for long hours on hard or Narrow surfaces (eg: during cycling) can lead to chronic coccygodynia. Degenerative changes that increase with age may lead to idiopathic Coccygodynia. Patients may also experience during Defecation and lean back or be standing up. In the pelvic examination, the coccyx palpated between the thumb and forefinger and is painful on palpation. Completion of another diagnostic workup should include Routine radiography and MRI can be performed on selected cases.

COCCYX

The word “coccyx” is derived from Greek; it refers to a cuckoo’s beak which resembles curved coccyx. A small triangular bone at the base of the spinal column in humans formed of fused vestigial vertebrae. It is commonly referred as Tailbone, is the final segment of the vertebra.

DEFINITION OF COCCYGECTOMY

Coccygectomy is a surgical procedure in which the coccyx or tailbone is removed.

Or

Coccygectomy is a removal of all or portion of the coccyx. Coccygectomy is performed to treat coccyx or tailbone pain. Because coccyx is broken or damaged it never completely heals.

INDICATIONS FOR COCCYGECTOMY

The indications are divided into 2 categories:

LOCAL CAUSES

  • Coccygodynia: Pain in the region of the coccyx (in cases where the conservative treatment fails).the pain symptoms may be particularly acute when an external force acts directly on the tailbone, particularly in sitting position.it bears the body weight during sitting. The treatment options for coccydynia (coccygodynia) are rest, anti-inflammatory drugs, and use of a cushion, appropriate physical therapy, and corticosteroid injections. If this measure fails surgical excision is preferred. Several studies have shown good to excellent outcomes in pain relief.
  • Congenital causes
  • Tumors
  • Trauma (fracture, fracture dislocations, and childbirth).
  • Degenerative
  • Psychosomatic
  • Unknown

  FACTORS FROM OTHER REGIONS

  • Episacral sarcoma
  • Lumbosacral injuries
  • Lower lumbar (spinal stenosis)
  • Pain from sacrococcygeal joint
  • Disk herniation or painful degenerated disk

SURGICAL PROCEDURE

On preoperative clinical examination, the patient shows marked tenderness on coccyx on palpation. And digital rectal examination performed to rule out a rectal based pathology. And patient should undergo non-contrast Radiographic imaging of the sacrum in two planes and an MRI scan of the sacrum.

  • Surgery is performed in the prone position and the patient should receive preoperative antibiotic prophylaxis.in most of the cases, a 5cm midline skin incision is made to perform surgery.
  • Typically the surgery is done with general anesthesia, and it lasts about an hour.
  • After dissection through the subcutaneous tissue, the fascia will be opened and the coccyx will be removed carefully by using electrocautery.
  • Hemostasis achieved by using hemostatic agent (eg; bone wax)
  • After the coccyx removed the dead space is obliterated by applying two to four mattress stitches with absorbable sutures.

AN IMPROVED SURGICAL TECHNIQUE OF COCCYGECTOMY

  1. Place the patient in jackknife position (knees drawn up to the chest)
  2. Make a 5cm or 3 inches cut in the skin from above the coccyx or sacrum joint down into the crease of the buttocks.
  3. Cut through to the coccyx, or cauterizing vessels that are cut through.
  4. Raise the tip of the coccyx by using a gloved finger.
  5. Cut the tip of the coccyx, away from the tissues around the anus.
  6. A wet sponge is used to separate rest of the coccyx from the tissues below it all the way up to the coccyx.
  7. Cut the tailbone (coccyx) off at the joint with the sacrum
  8. After cutting coccyx sacrum tip may look rough, file it down.

The advantages of this method are:

  • Minimal tissue dissection
  • Less chance of infection
  • Avoidance of rectal injury
  • Facilitates rapid healing
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POSTOPERATIVE CARE

After the procedure, patients are usually on oral antibiotics for 4-6 days or 2 or 3 doses. The patient is discharged from hospital 3-5 days if no immediate complications. Sutures are removed after 2 weeks. Dressing changed every 3 days. The patient is followed for a period of 12-36 months. Most common complications are:

  • Post-operative infection
  • Rectal injury
  • Fecal incontinence

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WHEN YOU NEED A COCCYGECTOMY?

You may need to undergo surgery when all other options such as physical therapy, medication or other non-operative therapies fail to address your condition. So, that’s when the option of surgery can come in handy as the last best resort.

GET A SECOND OPINION BEFORE THE COCCYGECTOMY

If you think that you are not satisfied with the treatment plan of your original doctor or you feel that your surgeon is not too forthcoming and transparent about why he or she has ruled out other treatment options, then its best to go for a second opinion. Your second doctor may help you choose an alternative which will save you both time and money. It is also possible that your second doctor may agree with the treatment plan and diagnosis of the first surgeon. In short, a second opinion will help you investigate other options available to you.

A second opinion is used as a ratification tool of your diagnosis and treatment plan suggested by your first doctor. These days, taking the second opinion has become an important part of proceeding any major treatment or surgery. One can obtain a second opinion either by traditional way or through online processes. In the traditional way, you can visit another physician’s clinic or hospital to get more information about your condition and to confirm your diagnosis. You should have enough time in your hand to take a second opinion traditionally, because it may require traveling; wait in the queue in the clinic, etc. which is not possible if your condition is critical. But online second opinion is quite easy and simple because you can get it from your home or any corner of the world. Online medical second opinion needs lower effort as compared to the traditional ways because you don’t have to spend much time on unnecessary traveling or waiting in the clinic or hospital.

Nowadays the physicians, especially those who are busy surgeons, spend hardly 5-6 minutes to see a patient. But, in online second opinion, both patient and doctor get enough time, to explain their problem and suggest a correct solution or therapy respectively. Online process also makes it easy to withhold information regarding the diagnosis or treatment plan decided by your first physician, which can help in getting an unbiased second opinion.  Sometime, the doctor may even be able to discuss your case with his or her while providing you with an online second opinion. So, online second medical opinion is better in many ways than the traditional ways.

Before taking an online second opinion, you should first prepare all your medical documents, including all the reports of the diagnostic tests, such as blood tests, x-rays, MRI, CT scans, etc. Also share all the medical facts you have, with your second physician. Make sure that you have conveyed all your medical history, including the present and past histories with clear information of the following facts:

  • You have an underlying disease
  • You are under any medication
  • You are allergic to certain drugs
  • Information of your BP, weight, height
  • You have an addiction to alcohol, smoking, tobacco chewing, etc.

It is always important to seek an online second opinion from a reliable company and website. Select only an authentic and trustworthy website which will work hard to correctly capture all your information and help you to receive a well-informed opinion.

There are chances that your second opinion will not match with the first doctor’s opinion. In that case, if you are not satisfied or have any doubt, you can always go for the third opinion to clarify the things. When you are confirmed about your diagnosis, it is your call with whom you will go ahead to begin the treatment. In some cases, the conditions are very sensitive and complex to take any decision. If it happens to you, you can take help from multiple doctors, who will see your case as a team.

If for some reason an experienced doctor is not available to you, then you can contact us here.

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