Coccygectomy
Encyclopedia
Coccygectomy is a surgical procedure during which the coccyx
, is removed. It can be performed for many reasons for instance in patients with coccyx pain (tailbone pain), however it is typically reserved for patients with malignant cancer or for patients whose tailbone pain has failed to respond to nonsurgical treatment (such as medications by mouth, use of seat cushions, and medications given by local injections done under fluoroscopic guidance).
In human
s, coccygectomy is the treatment of last resort for coccydynia
, but is considered a required treatment for sacrococcygeal teratoma
and other germ cell tumor
s arising from the coccyx.
To preserve normal defecation
, coccygectomy normally is accompanied by re-attachment (also known as re-approximation) of the two levator ani
muscles and of the perineum
, parts of the pelvic floor
. In adult
s who undergo coccygectomy, one infrequent complication is a subsequent perineal hernia
or coccygeal hernia. In these hernias, bowel or other pelvic contents bulge downward and out of the pelvis through a weakened pelvic floor. This complication has not been reported in persons who underwent coccygectomy when a baby or child
. A milder version of hernia is when someone just has prolapse (sagging) of the pelvic floor.
To repair these hernias, a variety of surgical techniques have been described.
An additional possible complication of coccygectomy includes infection at the surgical site. The fairly common occurrence of these post-operative infections is apparently due to the site's proximity to the colon and anus, thus leading to bacterial contamination of the surgical site by bacteria from the patient's stool (bowel movements). This may result in the need for repeat surgery at that site to treat the infection, in approximately 20% of coccygectomy patients.
Another complication is prolonged pain at the surgical site, or failure to relieve the pain that the patient was having prior to surgery.
Coccyx
The coccyx , commonly referred to as the tailbone, is the final segment of the vertebral column. Comprising three to five separate or fused vertebrae below the sacrum, it is attached to the sacrum by a fibrocartilaginous joint, the sacrococcygeal symphysis, which permits limited movement between...
, is removed. It can be performed for many reasons for instance in patients with coccyx pain (tailbone pain), however it is typically reserved for patients with malignant cancer or for patients whose tailbone pain has failed to respond to nonsurgical treatment (such as medications by mouth, use of seat cushions, and medications given by local injections done under fluoroscopic guidance).
In human
Human
Humans are the only living species in the Homo genus...
s, coccygectomy is the treatment of last resort for coccydynia
Coccydynia
Coccydynia is a medical term meaning pain in the coccyx or tailbone area, usually brought on by sitting too abruptly.-Diagnosis:A number of different conditions can cause pain in the general area of the coccyx, but not all involve the coccyx and the muscles attached to it. The first task of...
, but is considered a required treatment for sacrococcygeal teratoma
Sacrococcygeal teratoma
Sacrococcygeal teratoma is a teratoma located at the base of the coccyx . It is thought to be a derivative of the primitive streak.-Natural history:...
and other germ cell tumor
Germ cell tumor
A germ cell tumor is a neoplasm derived from germ cells. Germ cell tumors can be cancerous or non-cancerous tumors. Germ cells normally occur inside the gonads...
s arising from the coccyx.
To preserve normal defecation
Defecation
Defecation is the final act of digestion by which organisms eliminate solid, semisolid or liquid waste material from the digestive tract via the anus. Waves of muscular contraction known as peristalsis in the walls of the colon move fecal matter through the digestive tract towards the rectum...
, coccygectomy normally is accompanied by re-attachment (also known as re-approximation) of the two levator ani
Levator ani
The levator ani is a broad, thin muscle, situated on the side of the pelvis.It is attached to the inner surface of the side of the lesser pelvis, and unites with its fellow of the opposite side to form the greater part of the floor of the pelvic cavity....
muscles and of the perineum
Perineum
In human anatomy, the perineum is a region of the body including the perineal body and surrounding structures...
, parts of the pelvic floor
Pelvic floor
The pelvic floor or pelvic diaphragm is composed of muscle fibers of the levator ani, the coccygeus, and associated connective tissue which span the area underneath the pelvis. The pelvic diaphragm is a muscular partition formed by the levatores ani and coccygei, with which may be included the...
. In adult
Adult
An adult is a human being or living organism that is of relatively mature age, typically associated with sexual maturity and the attainment of reproductive age....
s who undergo coccygectomy, one infrequent complication is a subsequent perineal hernia
Perineal hernia
Perineal hernia is a hernia involving the perineum . The hernia may contain fluid, fat, any part of the intestine, the rectum, or the bladder. It is known to occur in humans, dogs, and other mammals, and often appears as a sudden swelling to one side of the anus.A common cause of perineal hernia...
or coccygeal hernia. In these hernias, bowel or other pelvic contents bulge downward and out of the pelvis through a weakened pelvic floor. This complication has not been reported in persons who underwent coccygectomy when a baby or child
Child
Biologically, a child is generally a human between the stages of birth and puberty. Some vernacular definitions of a child include the fetus, as being an unborn child. The legal definition of "child" generally refers to a minor, otherwise known as a person younger than the age of majority...
. A milder version of hernia is when someone just has prolapse (sagging) of the pelvic floor.
To repair these hernias, a variety of surgical techniques have been described.
Complications and Risks
First there are the risks that are associated with the General Anesthesia itself.An additional possible complication of coccygectomy includes infection at the surgical site. The fairly common occurrence of these post-operative infections is apparently due to the site's proximity to the colon and anus, thus leading to bacterial contamination of the surgical site by bacteria from the patient's stool (bowel movements). This may result in the need for repeat surgery at that site to treat the infection, in approximately 20% of coccygectomy patients.
Another complication is prolonged pain at the surgical site, or failure to relieve the pain that the patient was having prior to surgery.