Coccygectomy is a surgical procedure in which the
coccyx
The coccyx (: coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horse anatomy, horses. In tailless primates (e.g. hum ...
or tailbone is removed. It is considered a required treatment for
sacrococcygeal teratoma
Sacrococcygeal teratoma (SCT) is a type of tumor known as a teratoma that develops at the base of the coccyx (tailbone) and is thought to be primarily derived from remnants of the primitive streak. Sacrococcygeal teratomas are Benign tumor, benign ...
and other
germ cell tumor
A germ cell tumor (GCT) is a neoplasm derived from primordial germ cells. Germ-cell tumors can be cancerous or benign. Germ cell tumors typically originate from the gonads (ovary and testis), but can arise in other areas of the body. Extragon ...
s arising from the coccyx. Coccygectomy is the treatment of last resort for
coccydynia (coccyx pain) which has failed to respond to nonsurgical treatment. Non surgical treatments include use of seat cushions, external or internal manipulation and massage of the coccyx and the attached muscles, medications given by local injections under fluoroscopic guidance, and medications by mouth.
To remove the coccyx, an incision is made from the tip of the coccyx to its joint with the sacrum. The coccyx is cut away from the surrounding tissues, cut off at the joint with the sacrum, and removed. If the tip of the sacrum is rough, it is filed down. The wound is closed in layers.
[An improved technic of coccygectomy. Clinical Orthopedics, 85: 143-145, 1972. Richard C Gardner. http://www.coccyx.org/medabs/gardner.htm][Prevention of post-coccygectomy infection in a series of 136 coccygectomies. International Orthopaedics, 2011, 35 (6): 877-81. Doursounian L, Maigne JY, Cherrier B, Pacanowski J. http://www.coccyx.org/medabs/doursou3.htm]
Complications and risks
As with any operation under anaesthetic, there are risks associated with
general anaesthesia
General anaesthesia (UK) or general anesthesia (US) is medically induced loss of consciousness that renders a patient unarousable even by painful stimuli. It is achieved through medications, which can be injected or inhaled, often with an analges ...
itself. An additional possible complication of coccygectomy is infection at the surgical site, due to the site's proximity to the anus, leading to contamination by bacteria from the patient's feces. An analysis of 24 studies of coccygectomy (covering 702 patients)
[Coccygektomi kan være en behandlingsmulighed ved kronisk coccygodyni (Coccygectomy may be a treatment option for chronic coccydynia)
Ugeskr Læger
2011 Feb 14; 173(7): 495-500. In Danish.
Aarby, Nanett Skjellerup (1), Trollegaard, Anton Mitchell (2) and Hellberg, Steen (2) http://www.coccyx.org/medabs/aarby.htm] reported that 19 studies (covering 493 patients) reported the post-surgery infection rate, while the other five studies gave incomplete information. Among the patients in the 19 studies with full information, the infection rate was 12%. In most cases the infection was superficial, but 4% of operations caused an infection that required repeat surgery to treat the infection. However, the use of prophylactic antibiotics, preoperative rectal enema, closure of the wound in two layers and use of a topical skin adhesive have been shown to reduce the rate of infection to 0%.
In adults who undergo coccygectomy, one rare complication is a subsequent
perineal hernia or coccygeal hernia. In these hernias, bowel or other pelvic contents bulge downward and out of the pelvis through a weakened pelvic floor. This complication has not been reported in persons who underwent coccygectomy while a baby or child. A milder version of hernia is when someone just has prolapse (sagging) of the pelvic floor. To repair these hernias, a variety of surgical techniques have been described.
Success rates
The coccygectomy operation had a poor reputation in the past, and some doctors still advise that the surgery should be avoided. However current data from clinical trials reports success rates of 50 up to 90%, a percentage that rises to 80-90% in patients that are considered to be 'good candidates' for this kind of surgery. A study that was published in 2001 covering a total of 702 patients found good or excellent results in 83% of cases.
See also
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Rump (croup)
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Docking (animal)
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Docking (dog)
Docking or bobbing is the amputation, removal of portions of an animal's tail. It should not be confused with cropping (animal), ''cropping'', the amputation of ears. Tail docking may be performed cutting the tail with surgical scissors (or a ...
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Coccyx
The coccyx (: coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horse anatomy, horses. In tailless primates (e.g. hum ...
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List of surgeries by type
Many Surgery, surgical procedure names can be broken into parts to indicate the meaning. For example, in gastrectomy, "ectomy" is a suffix (linguistics), suffix meaning the removal of a part of the body. "Gastro-" means stomach. Thus, ''gastrectom ...
References
External links
Coccygectomy Information{{Operations and other procedures on the musculoskeletal system
Surgical oncology
Surgical removal procedures
Orthopedic surgical procedures