Introduction: We have compared the results of pedicle screw (PS) construct only with a hybrid sublaminar wire and pedicle screw construct (HS) in a matched cohort of CP patients, to establish which technique is superior in view of deformity correction and its maintenance.

Methods: 22 male and 14 female CP patients with average age of 16 years (range 8–25 years) underwent surgical correction for spinal deformity. Indications for surgery included loss of sitting balance, progression of spinal deformity, pelvic obliquity and back pain. Group 1 (18 patients) had PS construct only and Group 2 (18 patients) had HS constructs. 32 patients (90%) required sacral fixation. 5 patients in Group 2 required anterior release. All patients had a minimum follow-up of 2 years (range 2–13 years). Clinical and radiographic analyses were performed in both groups.

Results: Mean Cobb angle in Group 1 improved from 650 (range 120–950) to 18.50 (range 0–280) and in Group 2 from 77.60 (range 400–1050) to 34.80 (range 100–620) [p < 0.05]. Mean pelvic obliquity in Group 1 improved from 14.30 (range 00–420) to 2.50 (range 00–50) and in Group 2 from 24.70 (100–510) to 9.70 (range 20–180) [p< 0.05]. Mean surgical time in Group 1 was 224 minutes as compared to 260 minutes in Group 2 [P< 0.05]. 6 patients in Group 2 had proximal junctional kyphosis and implant failure requiring revision. One patient in each group had infection treated with antibiotic therapy.

Conclusions: PS fixation in CP patients, allowed significant correction of large curves without anterior release, eliminated proximal junctional kyphosis and instrumentation failure. Correction of pelvic obliquity was also superior due to three-dimensional corrective force of pedicle screws. Although PS fixation is expensive and technically demanding, it outweighs the costs incurred by two-stage surgery because of its superior durability correction.

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.