Steps to deciding to have tailbone removal surgery (coccygectomy)

For people who suffer with tailbone pain or coccydynia (coccyx pain), it can be difficult to decide whether or not to have the coccyx surgery to remove the tailbone (coccyx removal surgery, also called coccygectomy). These steps will focus on helping people and their doctors decide whether to consider tailbone removal surgery or a coccygectomy as part of the treatment of tailbone pain.

1. The first step is to find out what the cause of your tailbone or coccyx pain is. Ideally, the diagnosis is done by seeing a physician with experience in evaluating and treating a variety of causes of tailbone pain. Tailbone pain can be a result of: coccyx fractures (fractured tailbone, “broken tailbone”, chipped tailbone, “cracked tailbone”), coccyx dislocations (dislocated tailbone), coccyx sprains (sprained tailbone), coccyx injuries from pregnancy (tailbone injuries while pregnant  or from childbirth, labor and delivery), tailbone injuries from sports and other causes (bruised tailbone from trauma) and tailbone pain, aching, soreness or tailbone discomfort that began without any trauma or injury at all. By knowing the cause of the tailbone pain, the physician can give individualized advice or treatment to help decrease the pain without surgery.
2. In cases where the tailbone pain is caused by cancer (tumor, malignancy), surgical removal of the coccyx might be the best treatment, if recommended by your doctor. However, fortunately, the vast majority of cases of tailbone pain are NOT caused by cancer.
3. Before considering a coccygectomy or tailbone removal surgery, it is usually recommended to first try non-surgical treatments for tailbone pain. Surgery should always be a last option if at all possible.
4. There are a variety of non-surgical treatments available without a physician, which include: using tailbone cushions or coccyx cushions (wedge cushions and/or donut cushions), taking over-the-counter (non-prescription) medications by mouth, and using caution to avoid exacerbations of tailbone pain (e.g., by avoiding sitting on surfaces that worsen the pain).
5. Non-surgical treatments available through a physician (medical doctor) include prescription strength medications (to relieve pain and/or decrease inflammation), either taken by mouth or applied topically to the skin over the tailbone. Also, a physician with experience treating coccyx pain can perform local injections at the tailbone region, such as nerve blocks and/or injections of anti-inflammatory medications (e.g., steroids similar to cortisone). Ideally, injections in the coccyx region are performed under fluoroscopic guidance (rather than “blind” injections), so that the physician can more precisely place the medication at the correct location (and avoid accidentally placing the needle into other pelvic structures). There are new/current injection techniques that were not available a few years ago.
6. Fortunately, the majority of patients with tailbone pain will get relief through the steps above. But for the small percentage of patients who have gone through the above steps yet still have severe tailbone pain substantially compromising their quality of life, it may be reasonable to consider surgery to remove the tailbone (coccyx removal surgery, coccygectomy).
7. Before you decide to proceed with a coccygectomy, make sure to find a surgeon who has a lot of experience in performing this particular surgery. Experience matters. In my experience, if the surgeon isn’t sure about it, find one who is.
8. An important step before the surgery would be to make a list of questions to ask the surgeon, including asking about risks, benefits, and the surgeon’s experience and expected outcomes.
9. Consider the potential benefits of the surgery. Despite the multiple potential risks (listed below), if patients are properly selected and if the surgeon is experienced at performing this particular (uncommon) surgery, the tailbone pain is improved in at least 2 out of 3 patients who have the tailbone removed.
10. Make sure to consider all of the risks of the surgery. Current publications of medical research (since 2000) have noted that even after undergoing the surgery as many as 1 out of every 3 patients may have pain that is still not relieved. Also, almost 20% of coccygectomy surgeries may be complicated by infections (requiring repeat surgery in 15% of patients who have the coccygectomy surgery). Some patients have postoperative pain (pain after surgery) that lasts as long as one year. Patients may be at risk for prolapse (sagging) of the pelvic floor.

In summary, consider the medical advice  often published by both surgeons and non-surgical physicians, both of whom often refer to coccygectomy as “a last resort.” Specifically, tailbone removal surgery may indeed be helpful for the small percentage of patients who fail to get adequate relief from first trying all of the non-surgical treatments (including current injection techniques). Doctors often recommend coccygectomy for coccyx pain only if patients have first tried the spectrum of non-surgical treatments.