Coccygectomy is an operation to remove part or all of the coccyx (tailbone). It is performed for chronic coccydynia (tailbone pain) that has not responded to non-operative treatment.
An incision is made in the midline over the coccyx. The coccyx is carefully dissected from its attachments (gluteal muscles, anococcygeal ligament, levator ani) and removed — either partially (distal segments) or completely. Care is taken to avoid the rectum and to close the wound in layers. The operation takes 30–60 minutes.
Coccygectomy is reserved for severe, disabling coccydynia that has not responded to at least six to twelve months of non-operative treatment including cushioning, physiotherapy, manual therapy, corticosteroid injection, and ganglion impar block.
Coccyx cushion (donut or wedge), physiotherapy (pelvic floor and coccyx mobilisation), corticosteroid injection, ganglion impar block, and ergonomic modifications. Most patients improve without surgery.
Dynamic X-rays (sitting/standing) to assess coccygeal mobility. MRI to exclude other pathology. Confirmation that the coccyx is the pain source (ideally with a diagnostic injection providing temporary relief).
Pain relief in approximately 80–90% of carefully selected patients. Improvement is gradual over weeks to months as the wound heals.
The location (near the natal cleft) makes wound healing challenging. Risk approximately 10–15%.
Tenderness over the surgical site for several weeks to months.
Fluid collection at the surgical site.
Risk approximately 5–10% due to the location.
Very rare but requires immediate repair.
A persistent draining tract.
Approximately 10–20% of patients have ongoing pain despite coccygectomy.
Rare.
General anaesthesia. Positioned prone with the buttocks taped apart.
Avoid sitting directly on the wound for four to six weeks (use a coccyx cushion). Wound care is important. Return to desk work (with cushion) at two to four weeks. Full recovery three to six months.
Wound check at two weeks. Review at six weeks and three months.
The wound is in a high-moisture area near the natal cleft, making infection and delayed healing more common than at other surgical sites. Meticulous wound care is important.
Most patients sit comfortably (on a cushion initially) within four to six weeks. Full sitting comfort may take three to six months.