A coccygectomy is the surgical removal of your coccyx. This maybe indicated when someone has responded well to injections but the benefit has only been short-lasting. The other indication is when you have a mis-shaped or previously damaged coccyx.
If your coccyx is causing you problems then removing it would seem to be a logical step forward. The difficulty with coccyx surgery is the location of the wound, and the biggest risk is that of wound break down or infection. If this occurs then it can take several weeks for the wound to heal.
A coccygectomy is carried out in the operating theatre under a general anaesthetic. The operation involves making a small incision over your coccyx and removing the coccyx. At the end of the procedure the wound will be closed with a dissolvable stitch and covered with a skin glue dressing.
You will normally be in hospital for 24-hours.
What Are The Risks of Coccygectomy?
The risk of wound problems / infection is 5-10%. If there is a problem with your wound then it will likely take several weeks to address. It may require you to have further surgery or have a special dressing applied designed to bring the edges of your wound together. If you have a wound problem then it is likely that you will have on-going pain / discomfort from the wound.
Blood loss is usually minimal with a coccygectomy.
Developing blood clots in the legs (deep vein thrombosis – DVT) is a risk of any surgery. We worry about DVTs as bits can break off a travel around your body. This is called an embolus. An embolus can affect your breathing, cause you to have a stroke, and could potentially be fatal. DVTs occur in approximately 1 in 200 patients having back surgery. An embolus is a much less common occurrence. We minimize the risk of DVT by asking patients to wear hospital stockings following their surgery (TEDS), and mechanical pumps during and immediately after surgery. These pumps squeeze your lower legs, helping the blood to circulate. They are put on when you go to sleep and stay on until you start to mobilize. We encourage early mobilization as this also helps to prevent DVTs. If a patient is considered to be high risk for a DVT then we will prescribe blood thinning medication for a couple of weeks after your surgery.
The rectum lies just anterior to your coccyx. There is a 1% of damaging your rectum with coccyx surgery. If this occurs then you may require surgery on your rectum to address this, potentially requiring a stoma to rest your rectum and allow it to recover (your bowel being bought out through your abdominal wall with your faeces being collected in a bag).
Scar tissue can form at the surgical site. It is possible that you replace a painful coccyx for a painful scar.
Risks Associated with Having an Operation Lying on your Front
When getting you ready for surgery, care is taken to ensure that everything is protected. The does however remain a small risk of pressure damage. This can cause some temporary skin damage to the tip of your nose and your chin. This would normally completely recover over 2-3 weeks. There is a very small risk of some damage to your vision. Visual damage is reported as occurring in 1 in 10 000 cases.
Following any operation there is a small risk of post-operative medical complications, such as chest infections or urine infections.
What Can I Expect Following Surgery?
When you wake up following your surgery you will feel bruised at the site of the operation. We try and minimize this by injecting local anaesthetic around the wound. The wound will be closed with a dissolvable suture and covered with a skin glue, so there will be no stitches that need to be taken out. You will be in hospital for 1 night. Before you go home the nurses will explain how you need to look after your wound.
For the first 2-weeks you will need to avoid sitting. For the next 4-weeks after this sitting needs to be kept to an absolute minimum. This is to allow the wound to heal without putting any undue tension on the wound.
Many patients can get back to work within a couple of weeks from surgery, although often with some restriction of activity.
There is no restriction with the DVLA, though there will be with your insurance company. You will need to be able to undertake an emergency stop, and be in complete control of your car at all times without being distracted by pain. If this is not the case then your insurance will NOT be valid. As driving requires you to be sitting, driving should be kept to a minimum for the first 6-weeks.
You should not fly for 2-weeks following your surgery. You should not undertake any long haul flights for 6-weeks. If traveling on a long haul flight within 6-months of your operation then you should wear your hospital stockings when flying.
Once your sciatica has resolved you must continue to look after your back. The fact that you have had a disc prolapse does not preclude a normal lifestyle. However, we would recommend that you:
You will be seen back in the clinic a 2-weeks after your surgery. An appointment will be made for you before you are discharged.