We applaud your journal and the authors Woon et al. [1] on the recent publication describing the coccygeal morphology and morphometry of computerized tomography (CT) scans of 112 adults without coccydynia. This article gives the most educational, detailed, and organized discussion we have ever seen on the topic of coccygeal CT findings in patients without coccyx pain.

Clearly, this article will be an extremely useful reference for clinicians and radiologists evaluating CT images in patients who actually do have tailbone pain. However, the findings reported in these non-coccydynia patients should not lead clinicians/readers to erroneously assume that similar imaging findings are necessarily clinically irrelevant when seen in symptomatic (coccydynia) patients. For example, a distal coccygeal bone spur (spicule) which may merely be an incidental finding in a non-symptomatic patient might be a substantial source of suffering in a patient who does indeed have coccydynia. A careful history and careful, detailed palpation on physical examination is necessary before discrediting such imaging findings as being merely normal variants.