Coccyx Manipulation and Coccygectomy

Manipulation and Coccyx Injection.

Coccyx is a small triangular bone at the very bottom of the spinal column. It comes from the Greek word for “cuckoo”, which resembles the bird's beak with the tip pointed downward.

Coccydynia is a condition where the coccyx, a small bone located at the base of the spine, causes pain and discomfort.

Various factors, including injury to the coccyx, prolonged sitting, repetitive strain, or childbirth, can cause Coccydynia. In some cases, the cause may be unknown.

If the symptoms persist despite conservatory measures like using cushioned seats, ice or heat therapy, physical therapy, or pain medication, then an injection at the sacrococcygeal joint is a viable option.

This injection typically contains a blend of corticosteroids and local anaesthetic. Apart from providing temporary relief, this injection can also help confirm the diagnosis, making it a useful diagnostic tool. The risks associated with these injections are generally low.

What happens before the Manipulation and Coccyx Injection?

Before the procedure, the patient will typically undergo a thorough evaluation by a specialist to determine the underlying cause of their pain and whether a Manipulation and Coccyx Injection is an appropriate treatment option.

This evaluation may include a physical exam, medical history review, and diagnostic tests such as imaging studies (e.g., X-rays, MRI, and CT scans).

If the specialist determines that a Manipulation and Coccyx Injection is appropriate, the patient will typically receive instructions on preparing for the procedure. This may include:

  • Discontinuing the use of blood-thinning medications, such as warfarin, for a specified period before the procedure
  • Do not stop any medication before talking to us.
  • Arranging for someone to drive them home after the procedure.
  • Inform us of any allergies, medications, or medical conditions you have. If there is an active infection, the procedure is not carried out.

What happens during the procedure?

The usual way to perform this procedure involves using a combination of sedation and local anaesthesia, although general anaesthesia might sometimes be recommended.

You will be asked to lie down either on your stomach or side, and the skin will be cleaned with an antiseptic solution. A radiograph will be used to guide the placement of a needle into the coccyx and surrounding ligaments, followed by the injection of a small volume of corticosteroid and/or local anaesthetic. The surgeon may also manipulate the coccyx using a gloved finger in the rectum if necessary. The injection typically only takes a few minutes to complete.

Patients are usually admitted for day surgery, meaning no overnight stay is required, as they are expected to recover rapidly from any sedation or anaesthesia.

What can I expect after the injection?

Temporary numbness caused by local anaesthesia may occur for a few hours after the injection. After the numbness has worn off, it is not uncommon for the pain to return, possibly even worse than before, until the corticosteroid takes effect. This may take several days or weeks, as steroid injections require some time to work.

Patients should continue to take their usual pain relief medication until they feel relief. It is important not to stop taking certain pain relief medication suddenly, such as morphine or neuropathic medication (e.g., gabapentin, pregabalin or amitriptyline), and gradually decrease the dosage as advised by their GP.

Although many patients experience relief from a coccygeal injection, the duration of the
benefit varies and may last for weeks, months, or even years. The injection can provide excellent pain relief for some patients, allowing them to continue with physiotherapy, remain active, and potentially lose weight if needed. However, some patients may be at increased risk of having a further episode of coccygeal pain. If an initial injection is helpful, a surgeon may offer to repeat the procedure, usually not for at least six months.

What are the potential side effects of the procedure?

The most frequently observed side effect of the injections is mild tenderness and/or bruising at the injection site, which typically resolves within a few days.
Fortunately, there are few risks associated with the injection.

Very uncommon risks are bleeding, infection, facial flushing (females), rise in blood sugars for diabetes patients and allergic reactions to the medications.

Although rare, seeking medical attention promptly is important if you feel unwell.

Please follow the BASS (British Association of Spinal Surgeons) website for more information.

Learn more about spinal condition:

Coccyx Pain: Uncover the underlying causes, symptoms, and impact of Coccyx Pain.