Coccygectomy for refractory coccygodynia: a systematic review and meta-analysis

Navraj S. Sagoo, Ali S. Haider, Paolo Palmisciano, Christopher Vannabouathong, Roberto Gonzalez, Andrew L. Chen, Nidhish Lokesh, Neha Sharma, Kylan Larsen, Ravinderjit Singh, Neha Mulpuri, Kevin Rezzadeh, Christie Caldwell, Lori A. Tappen, Kevin Gill, Shaleen Vira

January 2022, Volume 31, Issue 1, pp 176 - 189 Review Article Read Full Article

First Online: 25 October 2021

Purpose

We sought to systematically assess and summarize the available literature on outcomes following coccygectomy for refractory coccygodynia.

Methods

PubMed, Scopus, and Cochrane Library databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data concerning patient demographics, validated patient reported outcome measures (PROMs) for pain relief, disability outcomes, complications, and reoperation rates were extracted and analyzed.

Results

A total of 21 studies (18 retrospective and 3 prospective) were included in the quantitative analysis. A total of 826 patients (females = 75%) received coccygectomy (720 total and 106 partial) for refractory coccygodynia. Trauma was reported as the most common etiology of coccygodynia (56%; n = 375), followed by idiopathic causes (33%; n = 221). The pooled mean difference (MD) in pain scores from baseline on a 0–10 scale was 5.03 (95% confidence interval [CI]: 4.35 to 6.86) at a 6–12 month follow-up (FU); 5.02 (95% CI: 3.47 to 6.57) at > 12–36 months FU; and 5.41 (95% CI: 4.33 to 6.48) at > 36 months FU. The MCID threshold for pain relief was surpassed at each follow-up. Oswestry Disability Index scores significantly improved postoperatively, with a pooled MD from baseline of − 23.49 (95% CI: − 31.51 to − 15.46), surpassing the MCID threshold. The pooled incidence of complications following coccygectomy was 8% (95% CI: 5% to 12%), the most frequent of which were surgical site infections and wound dehiscence. The pooled incidence of reoperations was 3% (95% CI: 1% to 5%).

Conclusion

Coccygectomy represents a viable treatment option in patients with refractory coccygodynia.

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