DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSIS: Coccydynia.
POSTOPERATIVE DIAGNOSIS: Coccydynia.
OPERATION PERFORMED: Coccygectomy.
SURGEON: John Doe, MD
ASSISTANT: Jane Doe, MD
ANESTHESIA: General.
INDICATIONS FOR OPERATION: The patient is a (XX)-year-old man with a long history of coccydynia. The cause of his coccydynia remains idiopathic. The patient’s pain progressed and ultimately required narcotic analgesics for management. He became habituated to the narcotics, they became ineffective, and a Dilaudid pump was placed to help minimize the systemic effects of oral analgesics. The pump was not effective in relieving his coccygeal pain, and he subsequently developed idiopathic flexion deformity of his cervical spine. Despite having a significant cervical flexion deformity, his primary complaint remained coccydynia. The patient elected to go ahead with coccygectomy. The patient’s physical exam certainly supported a coccydynia and dysmorphic coccyx. It was very tender to palpation and appeared to be broken. A CT scan was performed of the lower coccygeal segment, and this showed evidence of a 90-degree angular deformity of the terminal coccyx. Understanding the risks and benefits of the surgery, the patient elected to proceed with coccygectomy in hopes that this might relieve his long-standing coccygeal pain.
DESCRIPTION OF OPERATION: The patient was brought to the operating room and placed under general anesthesia. He was then placed prone on a Wilson frame. All bony prominences were inspected and padded prior to sterile draping. The sacrococcygeal area was then prepped and draped in the usual sterile fashion.
Using a #15 blade knife, the skin was incised in the midline over the terminal coccygeal segment. Monopolar cautery was then used to expose the terminal coccygeal segment. The coccygeal segment was released from soft tissue attachments using monopolar cautery and removed. It was clearly dislocated from the intact sacral segment. A Leksell rongeur was then used to contour the terminal sacral segment to prevent it from being prominent.
The wound was copiously irrigated with antibiotic solution. The terminal coccygeal segment itself was sent for pathology. The fascia was then reapproximated using interrupted 0-Vicryl sutures, and interrupted 3-0 Vicryl sutures were used to reapproximate the subcuticular layer. A sterile Dermabond dressing was then placed. The patient was extubated in the operating room and transferred to the recovery room in stable condition. There were no complications.
