Objectives: The results of coccygectomy were evaluated in patients with coccydynia unresponsive to conservative treatment. Methods: Twenty-four patients (23 females, 1 male; mean age 33 years; range 21 to 60 years) underwent coccygectomy for coccydynia unresponsive to conservative treatment of at least a year. The mean symptom duration was 30 months (range 14 to 144 months), and the mean length of conservative treatment was 18 months (range 12 to 32 months). Eighteen patients had a history of trauma and six patients were considered idiopathic. According to the radiographic classification of Postacchini and Massobrio, four patients (16.7%) were type 1, 16 patients (66.7%) were type 2, three patients (12.5%) were type 3, and one patient (4.2%) was type 4. Coccygectomy was performed according to the technique described by Key and complete excision was confirmed by radiologic examination. All the patients received postoperative dual antibiotic therapy for 72 hours. The mean follow-up was 28 months (range 12 to 70 months). Functional evaluations included the extent of relief in the painful area, improvement in quality of life, the severity of pain in the sitting position, and pain score during daily activities. Results: None of the patients required reoperation for incomplete excision. The results were excellent in 13 patients (54.2%), good in seven patients (29.2%), moderate in two patients (8.3%), and poor in two patients. Excellent and good results amounted to 83.3%. The only postoperative complication was infection in two patients, which was treated with antibiotics and appropriate wound care. None of the patients had rectal rupture or prolapse. Conclusion: Coccygectomy is a successful treatment option in patients unresponsive to conservative treatment for coccydynia.