Coccygectomy, primary
CPT4 code
Name of the Procedure:
Coccygectomy, primary
Common name(s): Coccyx Removal Surgery, Tailbone Removal Surgery
Technical term: Coccygectomy
Summary
A coccygectomy is a surgical procedure that involves the removal of the coccyx, or tailbone, which is the small bony structure at the base of the spine. This procedure is typically considered when other treatments have failed to alleviate chronic pain in the coccygeal region.
Purpose
The goal of a coccygectomy is to relieve chronic and debilitating pain originating from the coccyx. This pain, often referred to as coccydynia, may arise from trauma, prolonged sitting, or unknown causes. The expected outcome is significant pain reduction or complete pain relief, improving the patient’s quality of life.
Indications
- Chronic coccydynia not responding to conservative treatments (e.g., physical therapy, pain medication)
- Persistent pain following a coccygeal fracture or dislocation
- Pain during sitting or activities that exert pressure on the coccyx
- Failure of other therapeutic modalities, such as injections or manipulations
Preparation
- Patients are typically instructed to fast for a specific period before the surgery (usually 8-12 hours).
- Adjustments to medications, especially blood thinners, may be necessary.
- Preoperative assessments, including imaging studies like X-rays or MRIs to evaluate the coccyx and surrounding anatomy.
Procedure Description
- The patient is placed under general anesthesia.
- An incision is made over the coccyx.
- The surrounding tissues are carefully dissected to expose the coccyx.
- The coccyx is removed using surgical instruments.
- The surgical site is closed with sutures or staples.
- A sterile dressing is applied to the incision area. Tools/Efforts: Scalpels, retractors, surgical scissors, and possibly electrocautery. Anesthesia: General anesthesia is commonly used to ensure the patient is asleep and pain-free during the surgery.
Duration
The procedure typically takes about 1 to 2 hours to complete.
Setting
Coccygectomy is usually performed in a hospital operating room or a specialized surgical center.
Personnel
- Surgeon (usually an orthopedic or general surgeon)
- Anesthesiologist
- Surgical nurses
- Operating room technician
Risks and Complications
- Infection at the surgical site
- Bleeding or hematoma formation
- Pain at the incision site
- Damage to surrounding nerves or tissues
- Delayed healing or poor wound healing
- Persistent pain or recurrence of symptoms
Benefits
The primary benefit is the reduction or elimination of chronic tailbone pain, which can significantly improve mobility, comfort, and overall quality of life. Pain relief may be noticed gradually over several weeks to months post-surgery.
Recovery
- Postoperative care includes pain management with medications and instructions on wound care.
- Patients are advised to avoid sitting for prolonged periods initially and to use a cushion or doughnut-shaped pillow when sitting.
- Recovery time varies, with most patients resuming normal activities within a few weeks to a few months.
- Follow-up appointments are necessary to monitor healing and address any complications.
Alternatives
- Conservative treatments such as physical therapy, ergonomic modifications, and pain management injections.
- Other surgical options could include less invasive procedures like nerve blocks or radiofrequency ablation.
- Pros: Alternatives are less invasive with fewer risks and shorter recovery times.
- Cons: They may be less effective for severe or persistent cases of coccydynia.
Patient Experience
During the procedure, the patient will be under general anesthesia and will feel no pain. Postoperatively, the patient may experience discomfort and pain at the surgical site, which is typically managed with prescribed pain medications. The use of special cushions for sitting and gradual return to activities can help ensure a smoother recovery.