Study: Coccygectomy effectively manages pain for patients with chronic coccydynia

LAS VEGAS — The pain of chronic coccydynia was effectively managed with total coccygectomy in about 70% of patients through 2-year follow-up, according to results of an observational case series study presented here.

Another 20% of the 70 patients treated with coccygectomy reported additional improvement afterwards, Gabriella Ode, MD, of Charlotte, N.C., said at the American Academy of Orthopaedic Surgeons Annual Meeting.

Edward N. Hanley Jr., MD, the study’s senior author, performed all the surgeries the investigators analyzed and Ode discussed during her presentation.

“This is the largest prospective study on the treatment of chronic coccydynia with coccygectomy with 2-year follow-up. We used patient-centered outcome metrics to compose an objective threshold for treatment success. We can conclude from our study that at 2 years, 70% met that threshold. Twenty percent had some additional improvement and 10% of patients were presumed to be no better or worse,” Ode said.

To be included the prospective study, which started as a randomized controlled trial that compared the outcomes of surgery to steroid injection, and later transitioned to an observational case series study, patients needed to have coccygeal pain longer than 2 months, have failed nonoperative treatment and have evidence of coccyx morphologic abnormality on radiographs.

Ode said 91% of patients had symptoms 1 year or longer. As the primary outcome measures, Ode and colleagues used the patients’ Oswestry Disability Index (ODI) and VAS pain scale scores and their SF-36 scores from baseline and at 1-year and 2-year follow-up.

Success with the procedure was defined as a 20-point reduction in the ODI score at 2 years, according to Ode.

Two-year results showed significant improvement in VAS and ODI scores (P < 0.0001). Furthermore, the 10 quality of life components of the SF-36 also improved significantly (P < 0.05). Ode discussed the wound healing complications that occurred in the series in 19.4% of patients, which she said included five deep infections.

“Certain patient characteristics, such as prior opioid use, psychiatric illness, poorer baseline health and high preoperative pain may correlate with poor outcomes,” Ode said. “However, while overall wound complications did not predict successful outcomes, the high risk of wound complications should be addressed with your patients at length before any surgical intervention is performed.” – by Susan M. Rapp

Reference:

Ode G, et al. Paper #626. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; March 24-28, 2015; Las Vegas.

Disclosure: Ode reports no relevant financial disclosures.