Treatment Options for Coccyx Fracture in Seniors: Rehab vs Surgery

Fracture of the first coccygeal vertebra (coccyx) - what treatment is recommended?

Hello, doctor.
My mother is in her 70s and generally mobile, but recently she fell backward while standing at home in the morning (suspected due to low blood pressure and dizziness; her blood pressure was indeed very low at that time).
She also experienced back pain, so we went to the emergency room for examination and observation.
An X-ray was taken that day, but no abnormalities were reported.
We were advised to follow up with family medicine two days later.
During the follow-up visit, the doctor reviewed the X-ray and discovered a fracture in the first coccygeal vertebra (sacral vertebra), explaining that we could choose between "rehabilitation" or "surgical treatment." We prefer to try rehabilitation first, and the doctor mentioned that we could find a nearby facility.
The next day, we consulted a nearby orthopedic clinic that offers rehabilitation services.
The doctor arranged for another X-ray and then recommended surgery (vertebroplasty) as it would be more effective, but did not mention rehabilitation.
I would like to ask: 1.
Can an elderly person recover from a fracture of the first coccygeal vertebra through rehabilitation? 2.
Is surgery (vertebroplasty) the only effective solution to this issue? Are there any other recommendations? I hope to receive your reply soon.
Thank you!

Mr. Huang, 30~39 year old female. Ask Date: 2021/04/03

Dr. Chen Bochen reply Orthopedics

1.
The fracture of the first lumbar vertebra seen on X-ray may not necessarily be an acute fracture; it could also be an old injury or a chronic deformity due to osteoporosis.
2.
To determine whether the fracture was caused by the recent fall, an MRI is needed, which can also assess for degeneration and any damage to adjacent bones.
3.
Treatment options include wearing a brace and using analgesics.
Generally, pain may last for 2-3 months, but there is a possibility that the fracture may not heal properly, leading to persistent pain or nerve compression that worsens symptoms.
-- Vertebroplasty, commonly referred to as bone cement injection, typically involves an incision of less than 0.3 cm and a surgery duration of under 30 minutes, with anesthesia usually consisting of local anesthesia combined with intravenous sedation.
If managed properly, patients may only experience mild pain immediately after the procedure.
Vertebroplasty is a common surgery, but it is not without risks; a small number of patients may experience complications such as cement pulmonary embolism or re-fracture.
-- Rehabilitation is not suitable for acute vertebral compression fractures, as it may only increase pain without therapeutic benefit.

Reply Date: 2021/04/03

More Info

When it comes to treating a coccyx fracture, particularly in seniors, there are several considerations to take into account, including the patient's overall health, the severity of the fracture, and the potential for recovery through rehabilitation versus surgical intervention.

1. Understanding Coccyx Fractures: The coccyx, or tailbone, is a small bone at the base of the spine. Fractures in this area can occur due to falls, especially in older adults who may have a higher risk of falls due to balance issues or low blood pressure, as you mentioned in your mother's case. Symptoms of a coccyx fracture can include localized pain, especially when sitting or standing, and discomfort during movement.

2. Rehabilitation as a Treatment Option: For many patients, especially seniors, rehabilitation can be an effective first-line treatment for coccyx fractures. Physical therapy focuses on strengthening the muscles around the pelvis and improving balance and coordination, which can help prevent future falls. Additionally, pain management strategies, such as the use of cushions when sitting, can alleviate discomfort. Many patients experience significant improvement with conservative management, allowing them to regain mobility and reduce pain over time.

3. Surgical Intervention: Surgery, such as a coccygectomy (removal of the coccyx) or the use of bone cement (vertebroplasty), is typically considered when conservative treatments have failed, or if the fracture is severely displaced or causing significant pain that affects the patient's quality of life. Surgical options can provide immediate relief from pain and may be more effective in certain cases, particularly if there are complications such as nerve compression or chronic pain that does not respond to rehabilitation.

4. Factors Influencing Treatment Choice: The decision between rehabilitation and surgery should consider several factors:
- Severity of the Fracture: If the fracture is stable and not significantly displaced, rehabilitation may suffice. However, if there is a risk of instability or if the fracture is causing severe pain, surgery may be warranted.

- Patient’s Health Status: Given your mother's age, her overall health, comorbidities, and ability to tolerate surgery should be evaluated. Some seniors may not be good candidates for surgery due to other health issues.

- Expected Outcomes: Discuss with the healthcare provider the expected outcomes of both rehabilitation and surgical options. Rehabilitation may take longer to show results, while surgery may provide quicker relief but comes with its own risks.

5. Consultation with Specialists: It may be beneficial to consult with both an orthopedic surgeon and a physical therapist. The orthopedic surgeon can provide insights into the necessity and risks of surgery, while the physical therapist can outline a rehabilitation plan tailored to your mother's needs.

6. Monitoring and Follow-Up: Regardless of the chosen treatment path, regular follow-up appointments are crucial to monitor progress and make adjustments to the treatment plan as necessary. If rehabilitation is chosen, ensure that there is a structured program in place and that your mother is compliant with the exercises and recommendations provided.

In conclusion, both rehabilitation and surgical options have their merits for treating a coccyx fracture in seniors. Starting with rehabilitation is often a prudent approach, especially if the fracture is stable and the patient is otherwise healthy. However, if significant pain persists or if there are complications, surgical options should be considered. Always ensure that decisions are made collaboratively with healthcare providers, taking into account the specific circumstances and health status of the patient.

Similar Q&A

Effective Home Recovery Tips for Coccyx Injury Rehabilitation

Hello, Director Su! I would like to ask how a patient with a coccyx injury can recover quickly during the rehabilitation treatment period at home. Thank you for your response!

Dr. Su Hongci reply Rehabilitation
Treatment for coccygodynia generally falls into conservative and surgical methods. Conservative treatment typically involves the use of analgesics to reduce pain, supplemented by donut-shaped cushions or gel seat pads to alleviate pressure and irritation on the coccyx. Additional...

Understanding Coccydynia: Treatment Options for Tailbone Fractures

In high school, I sustained an injury that caused severe pain at the time. I didn't pay much attention to it until recently when I sought medical attention and was diagnosed with a coccygeal fracture. What treatment options are available?

Dr. Lin Junliang reply Orthopedics
If there is no displacement in a coccygeal fracture, conservative treatment is generally the primary approach (rest and medication). Riding motorcycles and bicycles should be avoided. In cases of displacement, manual reduction may be performed, followed by conservative treatment....

Understanding Hip Fracture Surgery Options for Elderly Patients

Hello, my grandfather has suffered a fracture between the left hip and the acetabulum due to a fall. The doctor has recommended surgery, but my grandmother had a similar situation where she underwent surgery and the internal fixation screws caused rejection and inflammation, lead...

Dr. Shi Guozheng reply Orthopedics
Fractures near the hip joint are usually best treated with surgery. Sometimes, internal fixation with screws is required, while in other cases, a total hip arthroplasty may be necessary, depending on the situation. Age is not a concern, and prompt surgical intervention leads to f...

Understanding Coccyx Fractures: Treatment Options and Recovery

Doctor, I fell down the stairs yesterday and landed on my buttocks. Today, after an X-ray, the doctor said I have a fractured coccyx and recommended outpatient surgery to reposition the bone. Is surgery absolutely necessary, or are there other treatment options available? Thank y...

Dr. Shi Guozheng reply Orthopedics
Coccygeal fractures typically do not require surgery; you can seek a second opinion at another hospital and consider conservative treatment.