Removal of the coccyx is termed coccygectomy. The coccyx is a small bone at the base of the spinal column and is usually ankylosed, articulating with the sacrum above.

The cause for the removal of the coccyx is pain from a contusion, a fracture, irritation of the coccygeal fibers, injury during childbirth, a lumbar disc (see Diagnostic Code: 5243 Intervertebral disc syndrome), or a sprain.

Coccydynia (painful coccyx) usually affects women. It can be referred pain or local pain. If the pain is referred from a disc, there is pain during sitting, and lumbar movements such as straight leg raising and coughing. If pain is not relieved by lying down, or continues at night, other causes such as a tumor may be investigated. Trauma from a fall in a half-sitting position causes contusion to this area, and is the true coccydynia. Pain is felt in the coccyx and does not spread. Coughing and sneezing do not cause pain, and only occasionally is walking painful.

If disc disease or spinal tumors are suspected, then appropriate diagnostic tests are performed. A routine physical examination and localized tenderness over the coccyx, or unilateral pain in the gluteus maximus, from a contusion will reveal true coccydynia.

Seating modifications need to be made to transfer weight from the coccyx to the ischia. Sessions of deep transverse friction to the ligaments may be a useful therapy. If friction therapy is unsuccessful, then steroid infiltration is usually done. If the pain is not relieved after conservative treatment, a coccygectomy is performed.

Surgical removal of the coccyx does not always have favorable outcomes. Postoperatively, there is a reported high incidence of gram-negative infections.

• The rating schedule for musculoskeletal was updated on February 7, 2021. Protection still does apply and should be considered with existing evaluations (38 CFR 3.951(a)).

• None.