Synonyms
Coccyx, Os coccygis
Introduction
In evolutionary terms, the coccyx represents a developmental artifact. It is considered to be a remnant of the tail of human ancestors. From an anatomical point of view, the coccyx of an upright person forms the lower section of the spine pointing towards the ground.
Besides the cervical, thoracic, lumbar and cruciate vertebrae, the coccyx thus represents the last part of the spinal column. Although it consists of firmly fused subunits, it plays an important role in various movement sequences. This is due to the fact that the coccyx serves as the point of attachment or origin of various ligaments and muscles of the pelvic area. In particular, the structures of the pelvic floor and the hip joint are fixed by connections to the coccyx.
Anatomy
The actual coccyx is composed of approximately four to five individual coccyx vertebrae. However, these vertebrae are fused into a single unified bone by a process called synostosis. In this context, the term synostosis describes a condition in which two bony structures that were previously connected to each other only by cartilage or connective tissue merge over time. Compared to the vertebral bodies of the cervical, thoracic or lumbar spine, almost all typical anatomical features have disappeared in the area of the coccyx.
Diseases of the coccyx
The coccyx is particularly at risk when falling on the buttocks. In addition, traumas in the area of the coccyx are often caused by direct force (for example, a kick) against this bony structure. Both classic fractures and dislocations are among the most common diseases of the coccyx.
Traumas of the spinal column end bone are characterized by severe pain, sometimes lasting for weeks, which is intensified when sitting or walking. Coccyx pain when sitting is the pain that occurs in the last and lowest section of the spine when sitting. The affected persons try to minimize the pain stimulus mostly by shifting weight to one side of the pelvis.
Taking painkillers can alleviate the symptoms for the time being. Paracetamol® (short: PCM) or Ibuprofen® are particularly suitable for the acute treatment of pain in the coccyx area. However, since the problems reappear quite quickly after the painkillers have taken effect, a doctor should always be consulted if coccyx pain occurs and appropriate diagnostics should be initiated.
Luxations of the coccyx are quite rare compared to dislocations of the hip or shoulder joint. In most cases, the presence of a luxation of the coccyx is not even diagnosed as such. Affected patients suffer from severe pain, which makes normal sitting almost impossible.
The treatment of coccyx dislocation is basically quite simple. After successful diagnosis, the treating doctor will insert the index finger into the rectum. Then the bone must be gripped and fixed from the rectum with the inserted finger.
The practitioner’s thumb should exert external pressure on the coccyx throughout the procedure. To release the dislocation and return the coccyx to its original position, it must be pulled slightly away from the sacrum with the index finger. At the same time, the sacrum should be pressed towards the feet.
If the reduction is successful, an immediate reduction in pain symptoms can be expected. If there is no corresponding pain relief, it can be assumed that the coccyx is still in a dislocated position and that the treatment was therefore not successful. Furthermore, it is possible that despite typical symptoms of dislocation, there are no problems in the coccyx area.
If severe pain is felt to the left or right of the sacrum during the repositioning attempt, this suggests that the sacroiliac joint in question is diseased. Even in the case of fractures of the coccyx (coccyx fracture), the affected patient usually feels rapid, severe pain. Furthermore, a fracture of the coccyx is clinically indicated by the appearance of bruises (technical term: hematoma), which are clearly visible while sitting.
While a simple contusion or luxation can be diagnosed and, if necessary, treated during a digital rectal examination, a coccyx fracture often presents a challenge. The diagnosis of fractures in the coccyx area can be made by taking X-rays.Immobilisation of such a fracture is virtually impossible due to the localisation. In most cases, the coccyx fracture is treated with painkillers.
Since the affected patients usually suffer from very severe pain, higher doses of painkillers can be taken. In addition, a so-called ring cushion can be used to relieve the strain while sitting. The pressure caused by the body mass is then not directed to the coccyx but increasingly to the buttock muscles.
If the pain symptoms do not subside within a few weeks despite these measures, surgical treatment of the fracture may be necessary. The coccyx fracture can be fixed during the surgical procedure. In extremely rare cases, however, the end piece of the coccyx must be completely removed.
A coccyx fistula is a chronic inflammatory disease that occurs in the area of the gluteal fold. Basically, it does not originate from the bony coccyx, but is much more often caused by hairs that have penetrated the skin. Nevertheless, coccyx fistulas can also be caused by severe contusions or congenital malformations of the coccyx.
Clinically, such a fistula is characterized by the sudden onset of severe pain, swelling and redness in the gluteal fold. In addition, the affected patients suffer from a sometimes extreme sensitivity to pressure. In the case of advanced coccyx fistulas, the discharge of bloody or purulent secretions from the fistula opening can be observed regularly.
If such a fistula is present, surgical treatment is the therapy of choice. Such an operation can be performed either on an outpatient or inpatient basis. There are different stages of coccyx fistula: as a prophylaxis, especially after an operated coccyx fistula, if it is known that there is a tendency to form a coccyx fistula, the hairs in the region should be removed by laser epilation, so that the hairs are destroyed down to the root.
The region should always be kept hair-free after the operation, also by shaving thoroughly and regularly.
- The so called blind form is a mild form of coccyx fistula and there are no signs of inflammation. However, the fistula opening is rarely visible on the skin.
- The acute abscessed coccyx fistula is festered because it has become inflamed (usually by heavy hair, sweat, rubbing of clothing, etc.
).
- The third stage is chronic coccyx fistula, which, although it does not show any acute signs of inflammation, causes symptoms through constant secretion of blood and pus and itching. It can often only be detected by blood/pus stains in underwear.
In order to successfully treat coccyx fistula, surgical opening of the fistula duct and thus surgery is absolutely necessary. Other forms of treatment are currently not considered promising.
In the classic surgical method, the coccyx fistula is usually stained with methylene blue. Then the tissue marked in this way is removed over a correspondingly large area. During the operation, an incision is made down to the coccyx and the periosteum is scraped off there to reliably prevent recurrences.
The operation is performed under general anesthesia, but in less severe cases it may also be performed under local anesthesia. In severe cases it may be necessary to stay in hospital for up to four days. In most cases, however, the operation is now performed on an outpatient basis.
The generous excision (cutting out) of the coccyx fistula is the classic therapy for coccyx fistula. Alternatively, there are also minimally invasive surgical techniques, such as the coccyx fistula operation according to Karydakis or pit-picking according to Bascom. These surgical techniques are considered to be painless in comparison to the classic variant.
They are partly performed endoscopically and are considerably more complex than the classic coccyx fistula operation. There are surgical techniques with flap plasty (Limberg plasty, rhomboid plasty, V-Y plasty), which work with displaced skin flaps. They are very complex, but if performed successfully, they can provide a more aesthetic appearance of the wound area and the healing rates are significantly more successful.
