Dynamic X-Ray Imaging and Its Role in Predicting Outcomes in Coccygectomy Patients: A Narrative Review

BackgroundChronic coccydynia is a debilitating condition often exacerbated by any activity that applies pressure to the coccygeal area. While diagnosis is primarily clinical, dynamic X-ray imaging has emerged as a valuable tool for identifying structural abnormalities like hypermobility or subluxation. For patients unresponsive to conservative treatments, coccygectomy (surgical removal of the coccyx) remains a definitive option. However, predicting surgical success remains challenging. ObjectiveThis narrative review synthesizes recent evidence (2015–2025) on the role of dynamic imaging in diagnosing coccydynia and its utility in predicting positive coccygectomy outcomes. Materials and MethodsA review of the literature was conducted to assess studies published between 2015–2025 focusing on dynamic X-ray imaging for identifying structural abnormalities (hypermobility, subluxation) and its role in predicting surgical outcomes for coccydynia. ResultsFindings suggest that patients with coccygeal instability, retroversion, or subluxation on dynamic imaging tend to experience better postoperative pain relief and quality-oflife improvements compared to those with normal or immobile coccyx. For instance, hypermobility (>25∘ flexion) or traumatic etiology may correlate with favorable surgical results, while idiopathic cases or normal anatomy often yield poorer outcomes. Despite these insights, limitations like small sample sizes, inconsistent imaging protocols, and lack of long-term data highlight the need for standardized guidelines. ConclusionClinical observations, along with our team’s decade-long experience, reinforce that dynamic imaging can refine patient selection by distinguishing those most likely to benefit from surgery. Future research should prioritize large, prospective studies with uniform imaging criteria and integrate psychosocial factors to optimize predictive accuracy. By addressing these gaps, dynamic imaging could evolve into a cornerstone of precision medicine for coccydynia, ensuring tailored treatments and improved surgical outcomes.