Clinical Outcome of Coccygectomy Using a Paramedian Curvilinear Skin Incision in Adults and Children With Meta-Analysis of the Literature Focusing on Postoperative Wound Infection

Abstract

Study design: A single surgeon case series and meta-analysis of literature.

Objective: To evaluate the clinical outcome and patient satisfaction following coccygectomy for coccygodynia in adults and children using a curvilinear paramedian skin incision and to conduct a meta-analysis of the literature to determine the associated infection rate with different surgical factors.

Methods: 45 consecutive patients (40 adults and 5 children) underwent surgical coccygectomy for persistent coccygodynia symptoms using a paramedian curvilinear incision. Postoperative clinical outcome scores, patients' satisfaction and wound complications were assessed. A systematic literature search using specific MesH terms was then conducted covering the period from 1980 to 2020. Only those studies reporting infection rates post coccygectomy were included in a meta-analysis.

Results: The average age of patients was 39 years with a mean duration of symptoms prior to surgery of 7.4 years. The mean Oswestry Disability Index improved from 29 to 7.7 (P < .001). The mean pain Visual analogue scale improved from 8 to 2 (P < .001) and the median patient satisfaction score was 8 (out of 10) suggesting good to excellent outcome. The clinical improvement was the same in children and adults. There was a total of 5 (11%) wound infections, 2 of which needed surgical debridement. Meta-analysis of the included studies showed that the use of prophylactic antibiotics for 24 hours, nonabsorbable skin sutures and glue were associated with low infection rate.

Conclusions: Coccygectomy using curvilinear paramedian skin incision for chronic coccygodynia is an effective procedure with similar or lower complication rates as reported in the literature.

Keywords: clinical outcome; coccygectomy; coccygodynia; paramedian skin incision; wound complications.

Figure 1.

Intraoperative photographs from draping to closure of the skin incision. During surgery the wound edges are gently retracted. The retractors shown here were used whilst taking photographs for demonstrating purpose. (A), Following the marking prepping and draping of the surgical field. The paracentral curvilinear line is marked before the incision. (B & C), following the exposure of the coccyx the hypermobile segment is identified and held with a towel clamp. The intervertebral disk at the mobile level is excised and the coccyx is elevated and gently freed from soft tissue attachment including the ano-coccygeal ligament. (D), the resected coccyx. (E), following excision of the coccyx meticulous haemostasis is ensured and the cavity is closed in layers over a suction drain. (F), the skin is closed with non-absorbable, interrupted nylon suture.

Figure 2.

The Oswestry Disability Index (ODI) significantly improved from a mean of 30.11 before surgery to a mean of 9.08 after surgery, p < .001, (paired t test).

Figure 3.

There was a significant improvement in the pain VAS after surgery, p < .001 (Wilcoxon Signed Ranks Test).

Figure 4.

Flow chart of the systematic search and review process of the articles included in the Meta-analysis.