Coccyx anatomy; questions and answers

Anatomy of the Coccyx (Tailbone) written By Richard A. Staehler, MD ,spinal-health.com The coccyx is a triangular arrangement of bone that makes up the very bottom portion of the spine below the sacrum. It represents a vestigial tail, hence the common term tailbone. Depending on an individual’s development, the coccyx may consist of three to five different bones connected by fused—or semi-fused—joints and/or disc-like ligaments. While it was originally thought that the coccyx is always fused together, it is now known that the coccyx is not one solid bone, but there is some limited movement between the bones permitted by fibrous joints and ligaments. The coccyx connects with the sacrum through the sacrococcygeal joint, and there is normally limited movement between the coccyx and the sacrum. The coccyx usually moves slightly forward or backward as the pelvis, hips, and legs move. When a person sits or stands, the bones that make up the pelvis (including the coccyx) rotate outward and inward slightly to better support and balance the body. Function of the Coccyx Although the tailbone is considered vestigial (or no longer necessary) in the human body, it does have some function in the pelvis. For instance, the coccyx is one part of a three-part support for a person in the seated position. Weight is distributed between the bottom portions of the two hip bones and the tailbone, providing balance and stability when a person is seated. The tailbone is the connecting point for many pelvic floor muscles. These muscles help support the anus and aid in defecation, support the vagina in females, and assist in walking, running, and moving the legs. Why Do More Coccyx Injuries Occur in Women Than Men? Coccydynia is generally much more common in women; some sources from the medical literature find that women are five times more likely to develop coccydynia than men. The majority of coccyx injuries occur in women because: A broader pelvic structure, which may decrease the amount of pelvic rotation and leave the coccyx more exposed to injury. Women tend to place more weight on the coccyx when sitting, which leaves it more susceptible to injury. Childbirth, which may cause acute damage as the baby moves over the tailbone Pelvic muscle cramps can also play a role in increased coccyx pain in women. In physical evaluations, women have reported significantly increased coccyx pain during the premenstrual period. Coccygectomy Surgery: For persistent pain that is not alleviated with non-surgical treatment and/or activity modification, surgical removal of all or a portion of the coccyx (coccygectomy) is an option. There are varying suggestions in the medical literature regarding how long non-surgical treatments should be tried before surgery is recommended. Some believe a two-month course of non-surgical treatment is sufficient, while others suggest non-surgical treatment should be tried for between three and eight months before surgery is advisable. Coccygectomy surgery is rarely recommended and performed. While the surgery itself is a relatively straight-forward operation, recovery from the surgery can be a long and uncomfortable process for the patient. Surgical Approach for Coccyx Pain: Surgeons may take slightly different approaches to the operation. Perhaps the biggest difference between surgeons is that some remove only part of the coccyx, while others recommend removing the entire coccyx. In general, the surgery involves the following steps: ●A one to two-inch incision is made over the top of the coccyx, which is located directly under the skin and subcutaneous fat tissue. ●There are no muscles to dissect away. ●The protective cartilage over the bone (the periosteum) is dissected from the bone starting on the back and carried around the front. ●The coccyx is then removed. It may receive a biopsy if a tumor is suspected. The operation takes about thirty minutes to perform and can be done on an outpatient basis. The most difficult part of the operation is the long healing process. Generally, it takes three months to a year after the surgery before patients see any relief from their symptoms, and sitting is difficult throughout the healing process. Indications for Coccygectomy Success Coccygectomy tends to be most successful in carefully selected cases. The following criteria have shown an increased chance of positive results after surgery: ●Patients whose pain is caused by changes in the shape of the coccyx, such as the presence of a spicule (a small bone spur at the end of the coccyx) ●Patients with excessive mobility of the coccyx ●The presence of a bursa, or a fluid-filled sac at the joint between the sacrum and coccyx Many studies have reported good or excellent results following coccygectomy surgery, but the procedure is not recommended for all patients. If a patient is not considered a good candidate for coccygectomy, non-surgical treatments will likely be adapted to the patient’s needs and attempted again. Potential Risks and Complications of Coccyx Surgery Perhaps the biggest risk is continued pain in the coccyx post-operatively, meaning that the patient has endured the long healing process and still has not had improvement in the symptoms. For this reason, patient selection is crucial to a positive surgical outcome. A possible but uncommon risk of coccygectomy is injury to the rectum as the coccyx is being removed. While it is unlikely, it is possible that if this were to happen, a diverting colostomy would be necessary to allow the rectum to heal. Other potential risks include wound healing difficulties and/or local infection, which can delay the overall healing process. Unlike most other spine surgeries, there are no significant nerve roots in the region that would be at risk Resourced and quoted from: https://www.spine-health.com/conditions/spine-anatomy/anatomy-coccyx-tailbone So a few questions that have been asked: ■ How can I constantly break my coccyx if it hasn't healed from previous breaks? Because the coccyx is bone and cartilage, as I've broken it over time its movement has become more free than fixed. This movement is much like; if a piece of hair fell infront of your face and you had to constantly tuck it behind your ears. But i move my coccyx left and right to clear it from obstruction of the bowel. Each brake is causing more scar tissue, more swelling and more pain. It also is wearing down my bowel wall. Much like rubber wears with repeating use. ■ How will removing the coccyx help, if CRPS is incurable? Great question. Yes CRPS is incurable, yet as stated by the article above. The tailbone is much like a stabiliser. Much like a cats tail, the tail doesn't support the cats spine but it allows the cat to balance and stabilise when jumping, running, etc. Well this is what our coccyx does for us. So when my coccyx is removed it will release the trapped nerves, tendons and ligaments. This will help decrease extra nerve messages being sent to my leg. And thus help my CRPS just be CRPS flares. Not aftermath flares, from rebreaking my coccyx everyday as the nerves in the pelvis wont be set off constantly. ■ What category does Mollie come under to be operable: Her's is excessive mobility of the coccyx. It is also broken into a U shape. ■ Will they remove the whole coccyx or part? At current we don't know this is a discussion and choice upto Mollie and Dr Donnellan once they meet in Sydney. Hopefully this helps answer some questions Many Blessings Mollie