Aims. The aim of this study was to identify factors associated with poor outcome following coccygectomy on patients with chronic coccydynia and instability of the coccyx. Methods. From the Danish National Spine Registry, DaneSpine, 134 consecutive patients were identified from a single centre who had coccygectomy from 2011 to 2019. Patient demographic data and patient-reported outcomes, including pain measured on a visual analogue scale (VAS), Oswestry Disability Index (ODI), EuroQol five-dimension five-level questionnaire, and 36-Item Short-Form Health Survey questionnaire (SF-36) were obtained at baseline and at one-year follow-up. Patient satisfaction was obtained at follow-up. Regression analysis, including age, sex, smoking status, BMI, duration of symptoms, work status, welfare payment, preoperative VAS, ODI, and SF-36 was performed to identify factors associated with dissatisfaction with results at one-year follow-up. Results. A minimum of one year follow-up was available in 112 patients (84%). Mean age was 41.9 years (15 to 78) and 97 of the patients were female (87%). Regression showed no statistically significant association between the investigated prognostic factors and a poor outcome following coccygectomy. The satisfied group showed a statistically significant improvement in patient-reported outcomes at one-year follow-up from baseline, whereas the dissatisfied group did not show a significant improvement. Conclusion. We did not identify factors associated with poor outcome following coccygectomy. This suggests that neither of the included parameters should be considered contraindications for coccygectomy in patients with chronic coccydynia and instability of the coccyx. Cite this article: Bone Jt Open 2021;2(7):540–544

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We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect.

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To determine if the results of treatment of adolescents with coccydynia are similar to those found in adults. Adult patients with coccydynia may benefit from injection therapy or operative treatment. There is little data evaluating treatment results in adolescents. We have treated adolescent patients similarly to adults and compared the outcomes.

First generation condylar knee replacements suffered from 2 prominent observations: Difficulty in stair climbing and Limited range of motion. Improved understanding of knee kinematics, the importance of femoral rollback, and enhanced stability in flexion led to 2 differing schools of thought: posterior cruciate ligament retention or posterior cruciate substitution. The advantages of posterior cruciate substitution include predictable CAM-post engagement leading to rollback, predictable ROM, stability during stair climbing, ease of knee balancing regardless of degree of angular deformity, and avoidance of issues such as PCL tightness / laxity at time of index procedure, as well as late ligament disruption leading to late instability. Evolution has shown that human appendages that no longer served a purpose, slowly shrivel up. As we have seen with the appendix, the coccyx, and the erector pili muscles, these vestigial organs no longer are necessary for daily function and are destined for obsolescence. I submit: the PCL in knee arthroplasty IS THE VESTIGIAL ORGAN: not the posterior stabilizing mechanism!

Aim: Retrospective review of patients after coccygectomy for post traumatic coccydynia. Methods: 13 patients (2 male, 11 female; mean age 37.8 years) who had undergone coccygectomy in our unit between 1995–2005 were identified and their case notes were reviewed. All patients had coccydynia with clear history of trauma, had failed to respond to three MUA and injections, and on clinical examination by senior author had hypermobile coccyx. All patients were operated by the senior author, using a standard technique whereby all segments of the coccyx from sacrococcygeal joint were excised. At follow up postal questionnaire was sent to all patients. This included, Visual Analogue Score (VAS) for Pain now and VAS for pain over one week, overall patient satisfaction, and Oswestry disability Index (ODI), The non-respondents were contacted by telephone 3 weeks later. Overall response was 100%. RESULTS: Mean time from the onset of symptoms to coccygectomy was 23.8 months (range 5–72). Average length of follow up was 3.8 years (range 0.7–10.8). 6 patients (46%) had 0 pain for VAS now and VAS over one week. 2 patients (15%) had mild pain VAS (1,2) for pain now and over 1 week, and 4 patients(31%) had moderate pain VAS (5,5,5,6) for pain now and VAS (5,5,5,5) for pain over 1 week and 1 patient (8%) had severe pain VAS (8). ODI was normal or mild disability (0–20%) in 8 patients (71%), 4 patients had moderate disability (ODI 21–40%) and 1 had sever disability (ODI 54%). Overall Ten patients (76.9%) were satisfied with the result and would consider the same surgery again. Conclusion: Surgical treatment of post traumatic coccydynia resistant to conservative measures can lead to satisfactory results, if appropriate patient selection criteria are applied

First generation condylar knee replacements suffered from two prominent observations: 1) Difficulty in stair climbing, 2) Limited range of motion (ROM). Improved understanding of knee kinematics, the importance of femoral rollback, and enhanced stability in flexion led to 2 differing schools of thought: Posterior Cruciate ligament retention vs. Posterior Cruciate substitution. The advantages of posterior cruciate substitution include predictable cam-post engagement leading to rollback, predictable ROM, stability during stair climbing, ease of knee balancing regardless of degree of angular deformity, and avoidance of issues such as PCL tightness / laxity at time of index procedure, as well as late ligament disruption leading to late instability. Evolution has shown that human appendages that no longer served a purpose, slowly shrivel up. As we have seen with the appendix, the coccyx, and the erector pili muscles, these vestigial organs no longer are necessary for daily function and are destined for obsolescence. I submit: the PCL in knee arthroplasty IS THE VESTIGIAL ORGAN: not the posterior stabilizing mechanism!

Coccygectomy, surgical excision of the coccyx, may be used to treat coccydynia, a chronic and disabling condition of the lowest part of the spine. It is a controversial and infrequently performed operation that many surgeons are reluctant to perform due to the risks of rectal perforation and infection. The criteria for patient selection for coccygectomy remain ill-defined. We present a single surgeon case series of 17 patients who underwent coccygectomy for chronic coccydynia. This was a retrospective observarional case series analysis. Case notes of 17 patients who underwent coccygectomy from 1999 -2009 were obtained and analysed. We then carried out telephone survey for which only 15 patients were contactable. We used the Milton Keynes Orthopaedic Patient Satisfaction survey and the modified Oswestry low back pain disability questionnaire. All patients had a two to three year history of coccydynia; 15 following trauma, one following a caudal injection and one following birth delivery. All patients had received between one and five lignocaine/methylprednisolone injections prior to coccygectomy, with documented initial symptom relief. All 17 patients had documented hypermobile sacro-coccygeal joints. Post-operative symptom relief varied between 60% and 100%, with all patients reporting that they would have their surgery again. Complications included three post-operative wound infections. There were no cases of rectal perforation. Coccygectomy for intractable coccydynia is sometimes the only option available. With good patient selection, including identification of a hypermobile joint with initial symptom relief following local injection, coccygectomy is a successful and safe treatment

Chordoma is low grade, locally aggressive and mainly in the sacrococcygeal region. Treatment is a combination of surgery and radiotherapy. We reviewed, to determine our outcome and functional deficits, the cases treated over 15 years by the senior author. Out of 26 chordoma’s referred 14 were in the sacrococcygeal region. We reviewed them retrospectively looking at presentation, diagnosis, surgical approach, neurological result, complications and survival. The mean age was 55 years (range 26–80 years), 9 males and 5 females. 13 were primary and 1 was recurrent. Patients reported 18 months of symptoms prior to diagnosis. The tumour sites were S1-5, S2-2, S3-2, S4-3, S5-1 and coccyx −1. Surgery was performed via an anterior/posterior-combined approach in 10, a posterior approach in 2, anterior in 1 and posterior/perineal combined in 1. Complete excision was possible in 11 cases. Surgical resection with radiotherapy was used for inadequate surgical margins, in 3 cases. Neurologically we found that we needed an intact unilateral S3 nerve root for continence in our series. All patients had minor wound complications, 2 wounds required further surgical intervention, and there were 2 cardiac arrhythmias, 1 pulmonary embolus. There were 5 recurrences, 3 were local and 2 metastatic. The survival data for 5 and 7 years is 88% and 71% respectively. Our disease free survival at 5 and 7-years was 44% and 57% respectively. We achieved an excellent 5 and 7-year survival in our series. The results following complete excision were best, but those treated with adjuvant radiotherapy also responded well. We saw that a solitary S3 nerve root is needed for continence. Treating by a combined anterior/ posterior approach suggests improved survival

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Slipped upper femoral epiphysis (SUFE) has well documented biochemical and mechanical risk factors. Femoral and acetabular morphologies seem to be equally important. Acetabular retroversion has a low prevalence in asymptomatic adults. Hips with dysplasia, osteoarthritis, and Perthes’ disease, however, have higher rates, ranging from 18% to 48%. The aim of our study was to assess the prevalence of acetabular retroversion in patients presenting with SUFE using both validated radiological signs and tomographical measurements.

This is a preliminary retrospective report on a novel technique for achieving fusion at the lumbo-sacral disc. Current methods of complete discectomy and instrumented fusion involve either a posterior approach and the insertion of cages or an anterior approach. Both methods involve quite extensive dissections with potential stabilising muscle stripping. They also require significant post operative analgesia, inpatient stay and post operative recovery. There are attendant risks of nerve injury, blood loss and thrombosis. A novel method of approach from the sacrum via a ‘safe zone’, described by Yuan et al., is presented. The technique along with the anatomical considerations is described. The operation basically consists of a posterior sacrococcygeal incision and an x-ray guided approach to the anterior surface of the S1/S2 junction with blunt obturators. The L5/S1 disc is then accessed by drilling through the sacrum. The disc is then removed from within with shaped tools leaving the bulk of the annulus. The void created is filled with bone graft and the L5 vertebra fixed to the sacrum via a bolt. The initial results of the first 20 patients are presented. 21 patients have been operated upon but one has been lost to follow up due to a psychological disorder. That patients details have been excluded. The patients underwent surgery between 4/7/06 and 8/10/07. All operative procedures were completed without complication, the operative time improving from 60 minutes to a ‘standard’ 45 minutes. There were no post operative complications. Two patients underwent additional procedures. One was an L4/5 Wallis ligament the other an inter-transverse non instrumented fusion. Several patients required a further pain control procedure, 3 caudal epidurals, 2 facet blocks and 2 coccyx injections. One patient required an L4/5 PLIF 12 months after the first procedure and two patients required posterior stabilisation at the same level. One after 4 months the other at 18 months. The indications for surgery are the same as for a standard fusion procedure. In this group there were 12 degenerative discs with mechanical LBP, 3 spondylolistheses, 2 previous failed posterior fusions and 3 post discectomy patients. Discography was used for confirmation of the pain source in 15 cases. The duration of symptoms ranged between 2–15 years with a mean of 6.25. There were 12 male and 8 female patients. The age ranged between 34–70 with a mean of 47. The female mean being 48 and the male 46. The Oswestry disability index showed a mean of 47 pre-operation and 23 post-operation. 13 out of 20 have been discharged with symptoms resolved or easily bearable. The hospital stay varied between 1 night and 4 nights with a mean of 3.3. This novel approach to the lumbar spine gives rapid and safe access to the lumbar disc space despite the unusual approach for spinal surgeons. Once the initial incision is made the procedure is carried out under x-ray control using techniques which are very familiar to Orthopaedic surgeons. The lack of intra-operative problems and post-operative complications testify to a safe procedure. The question mark remains on the rate of fusion. Two patients and potentially a third required a secondary posterior instrumented fusion. One was due to demonstrable loosening of the bolt and the other two continued pain possibly due to inadequate stabilisation. In my view, despite the European teaching, posterior instrumentation is desirable. This can be achieved via a percutaneous technique

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Socioeconomic and racial disparities have been recognized as impacting the care of patients with cancer, however there are a lack of data examining the impact of these disparities on patients with bone sarcoma. The purpose of this study was to examine socioeconomic and racial disparities that impact the oncological outcomes of patients with bone sarcoma.