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Deviandri R, Pribadi BPP, Wiranata M. The mini-open procedure with a modified figure of eight for managing sacrococcygeal fracture-dislocation: A case report and literature review. Int J Surg Case Rep 2024; 119:109769. [PMID: 38788633 PMCID: PMC11143786 DOI: 10.1016/j.ijscr.2024.109769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/10/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE A fracture associated with an anteriorly displaced fragment may induce soft tissue disintegration. However, this might be avoided by maintaining the stability of the sacrococcygeal bone. Fixation by using less invasive modalities is needed to improve the outcome. CASE PRESENTATION A 37-year-old female came with tailbone pain, which lasted around one month. There was a history of falling in a sitting position a month before hospital admission. Tenderness was positive while palpating the perineal site. A radiography examination shows a fracture in the sacrococcygeal segment with anterior dislocation. The patient was diagnosed with a sacrococcygeal fracture and anterior dislocation. CLINICAL DISCUSSION We performed a mini-open procedure using a modified figure-of-eight technique to reconnect the sacrococcygeal bone. Suturing was performed through the skin in the painful area, and then the bone at the injured site was reduced. As an outcome, there was an improvement in the Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and EuroQol-5 Dimensions (EQ5D) scores. CONCLUSION A mini-open procedure with a modified figure of eight is a simple and valuable method for correcting the sacrococcygeal components.
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Affiliation(s)
- Romy Deviandri
- Department of Surgery-Faculty of Medicine, Universitas Riau, Arifin Achmad Hospital, Pekanbaru, Indonesia; Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
| | - Bayu Pratama Putra Pribadi
- Department of Surgery-Faculty of Medicine, Universitas Riau, Arifin Achmad Hospital, Pekanbaru, Indonesia
| | - Muhammad Wiranata
- Department of Surgery-Faculty of Medicine, Universitas Riau, Arifin Achmad Hospital, Pekanbaru, Indonesia
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Nasiri A, Farajzadeh Vajari F, Sane S, Afsargharehbagh R. Assessment of Ganglion Impar Block Effect on Treatment Results of Coccydynia: A Cross-Sectional Study. Anesth Pain Med 2024; 14:e142137. [PMID: 38741900 PMCID: PMC11088838 DOI: 10.5812/aapm-142137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 02/13/2024] [Accepted: 02/14/2024] [Indexed: 05/16/2024] Open
Abstract
Background The ganglion impar block is a minimally invasive technique used for alleviating pain associated with coccydynia. Objectives This research evaluates the effectiveness of the ganglion impar block in treating patients with coccydynia who have not benefited from conservative treatments. Methods This cross-sectional analysis reviewed the clinical records of coccydynia patients who received ganglion impar block injections at Urmia Imam Khomeini Hospital, Urmia, Iran, between 2020 and 2022. Data regarding age, gender, body mass index (BMI), onset of pain, and levels of patient satisfaction post-treatment were gathered from the medical records. Results The study comprised 26 patients, with 4 (15.4%) being male and 22 (84.6%) female. The average age and BMI were 39.15 ± 14.24 years and 28.91 ± 2.14 kg/m2, respectively, which did not show significant variation (P = 0.19). The average Visual Analogue Scale (VAS) score before the ganglion impar block was 6.23 ± 2.35, which reduced to 4.47 ± 2.41 immediately after the procedure. At the 1-month follow-up, the average VAS score had further decreased to 3.47 ± 0.79. The decrease in VAS scores, both immediately after the procedure and at the 1-month follow-up, was statistically significant. The success rate of the block (defined as a reduction in pain of at least 20% from the baseline) was significantly high immediately and one-month post-procedure (P < 0.001). Out of the 26 patients treated with the impar block, satisfaction rates were 42.3% excellent, 27% good, 19.2% fair, and 11.5% poor. Conclusions The study endorses the trans-sacro-coccygeal "needle inside needle" method for providing relief to patients suffering from coccydynia. The findings revealed significant patient satisfaction, with the majority describing their experience as excellent.
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Affiliation(s)
- Aliakbar Nasiri
- Department of Anesthesiology, Faculty of Medicine, University of Medical Sciences, Urmia, Iran
| | | | - Shahryar Sane
- Department of Anesthesiology, Faculty of Medicine, University of Medical Sciences, Urmia, Iran
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Martens JM, Fiala KJ, Kalia H, Abd-Elsayed A. Radiofrequency ablation and pulsed radiofrequency ablation for the sympathetic nervous system. RADIOFREQUENCY ABLATION TECHNIQUES 2024:186-201. [DOI: 10.1016/b978-0-323-87063-4.00025-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Lota KS, Malliaropoulos N, Bikos G, Lohrer H. Radial extracorporeal shockwave therapy (rESWT) for coccydynia: a prospective study of 14 patients. Ann Med Surg (Lond) 2023; 85:4656-4661. [PMID: 37811013 PMCID: PMC10553196 DOI: 10.1097/ms9.0000000000001133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/25/2023] [Indexed: 10/10/2023] Open
Abstract
Background Coccydynia is defined as pain in the coccyx. We investigated the effect of radial extracorporeal shockwave therapy (rESWT) in the management of coccydynia. Methods In this prospective study, patients (≥18 years) diagnosed with coccydynia at a sports clinic located in Thessaloniki, Greece, were eligible for rESWT treatment when they reported a visual analogue scale (VAS) pain level ≥6. Treatment sessions were once weekly and ended when VAS pain levels decreased to ≤3. Recurrence rates were documented at 3-month and 12-month follow-ups. Results Fourteen patients were treated using rESWT. The mean age and symptom duration of our cohort was 33.6±7.9 (range: 20-45) years and 9.4±8.5 (range: 3-36) months, respectively. The mean number of treatment sessions per patient was 6.4±1.6 (range: 4-8). The mean device pressure, frequency, and number of pulses was 1.2±0.1 (range: 1-1.4) bar, 5.0±0.1 (range: 5-6) Hz, and 2082±74.8 (range: 2000-2300) pulses, respectively. Treatment alleviated pain in all patients, and no recurrence of symptoms was reported during follow-up. There was a positive correlation between symptom duration and the number of treatment sessions (r=0.701, P=0.005). Pairwise comparison highlighted significant reductions in VAS pain levels between each stage of treatment (P<0.001). Conclusion Our study affirms the safety and efficacy of rESWT in managing coccydynia.
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Affiliation(s)
- Kabir Singh Lota
- Barts and The London School of Medicine and Dentistry
- Centre for Sports and Exercise Medicine, Queen Mary, University of London
| | - Nikos Malliaropoulos
- Centre for Sports and Exercise Medicine, Queen Mary, University of London
- Sports Clinic, Rheumatology Department, Barts Health NHS Trust, London, UK
- Sports and Exercise Medicine Clinic
| | - Georgios Bikos
- Euromedica – Arogi Rehabilitation Center, Thessaloniki, Greece
| | - Heinz Lohrer
- European Sportscare Network (ESN), Zentrum für Sportorthopädie, Wiesbaden-Nordenstadt
- Department of Sport and Sport Science, Albert-Ludwigs-Universität Freiburg i. Brsg., Freiburg, Germany
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Gündüz OH, Okçu M, Şencan S. Follow-up of at least 3 years after ganglion impar block for control of chronic coccygodynia. Somatosens Mot Res 2023; 40:97-102. [PMID: 36891582 DOI: 10.1080/08990220.2023.2186391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 02/27/2023] [Indexed: 03/10/2023]
Abstract
INTRODUCTION Although it is well known that ganglion impar block (GIB) reduces pain in the short term in patients with chronic coccygodynia, there are insufficient data on long-term treatment outcomes. The aim of this study was to examine the long-term outcomes of patients who underwent GIB for chronic coccygodynia and possible factors that might affect these outcomes. METHODS The pre-treatment, 1st-hour, and 3rd-week numeric rating scale (NRS) scores of patients who underwent GIB 36-119 (min-max) months ago (between November 2011 and October 2018) due to coccygodynia were obtained from the medical records. Final NRS scores and presence of factors that may affect success such as accompanying low back pain (LBP) were questioned via telephone interviews. Treatment success was defined as a 50% or more reduction in final NRS scores compared with pre-treatment NRS scores. RESULTS Telephone interviews were made with 70 patients. Treatment success was achieved in 55.7% of the patients. The patients were divided into two groups as those who achieved treatment success (group A) and those who could not (group B) and were compared. The NRS scores at the 3rd week and the number of patients with LBP in the group B were significantly higher than the group A. No serious complications developed in any patients. CONCLUSION In patients with chronic coccygodynia, GIB is an effective and safe treatment option for pain reduction in the long term. Accompanying LBP and high pain scores in the 3rd week after injection should be considered as parameters that negatively affect long-term treatment success.
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Affiliation(s)
- Osman Hakan Gündüz
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Okçu
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
| | - Savaş Şencan
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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Okçu M, Şencan S, Hakan Gündüz O. Rare complication of ganglion impar blockade with the transsacrococcygeal approach: A case of rectal perforation. Turk J Phys Med Rehabil 2023; 69:121-124. [PMID: 37201018 PMCID: PMC10186016 DOI: 10.5606/tftrd.2022.8874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 08/22/2021] [Indexed: 05/20/2023] Open
Abstract
Although it has been reported that caution should be exercised in terms of rectal perforation, as the ganglion impar is located just behind the rectum in the presacral space, the authors could not find any case or images of rectal perforation occurring during ganglion impar blockade in the literature. In this report, the case of a 38-year-old female with rectal perforation that developed during ganglion impar blockade, performed by the transsacrococcygeal approach under fluoroscopy guidance, is presented. Wrong needle selection and the structurally short presacral space of the patient may have influenced the development of rectal perforation in the patient. This study presents the first case and images of rectal perforation in the literature that developed during the application of ganglion impar blockade using the transsacrococcygeal technique. In ganglion impar block applications, technically appropriate needles should be used, and care should be taken in terms of rectal perforation.
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Affiliation(s)
- Mehmet Okçu
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Savaş Şencan
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
| | - Osman Hakan Gündüz
- Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Faculty of Medicine, Istanbul, Türkiye
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Akşan Ö. Management of Persistent Coccygodynia and Health Behavior: A Survey Study on Patients with Coccygodynia of Age 41 to 69 years. Am J Health Behav 2022; 46:821-833. [PMID: 36721295 DOI: 10.5993/ajhb.46.6.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives: Coccygodynia, with trauma as a common etiologic factor, is a clinical condition of pain around the coccygeal region. This research aimed at investigating the level of satisfaction in surgical and non- surgical treatment of coccygodynia among Turkish patients and their health behavior. Methods: There is no dearth of studies on coccygodynia; however, a clear gap in research exists of studying coccygodynia patient satisfaction of specific age groups. Turkish patients aged 41 to 69 years and suffering from coccygodynia in different public sector clinics were the respondents in this research. The major criteria of sampling were Turkish patients of coccygodynia, aged 41 to 69 years, satisfied with both surgical and non-surgical methods of treatment, and varying in the nature of the infection. Results: The study found out that coccygodynia patients had a higher probability to receive timely, successful treatment; and that there exists a positive relationship between coccygodynia patients' health behavior and coccygodynia treatment satisfaction.Conclusion: This research is a significant contribution understanding the patients with coccygodynia, and whether they improved their health in a better way with surgical or non-surgical method of treatment.
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Affiliation(s)
- Özgür Akşan
- Özgür Akşan, İstanbul Aydın University, Department of Neurosurgery, İstanbul, Turkey. Beşyol, Ínönü Cd. No:38, 34295 Küçükçekmece/İstanbul, Turkey;,
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Chang Chien G, Patel A, Wang D. Bipolar radiofrequency ablation of the anococcygeal nerve for the treatment of chronic coccydynia: A case report. INTERVENTIONAL PAIN MEDICINE 2022; 1:100115. [PMID: 39238516 PMCID: PMC11372932 DOI: 10.1016/j.inpm.2022.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/12/2022] [Accepted: 06/12/2022] [Indexed: 09/07/2024]
Affiliation(s)
- George Chang Chien
- Pain Management, Ventura County Medical Center, Ventura, CA, USA
- GCC Institute for Regenerative Medicine, Irvine, CA, USA
| | - Ankur Patel
- New York Presbyterian Hospital - Columbia University Medical Center and Weill Cornell Medical Center, USA
| | - Daniel Wang
- Kansas City University, Kansas City, MO, USA
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Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE The aim of this article was to evaluate the results of patients operated for chronic coccydynia, and determine any factors that could affect outcomes. SUMMARY OF BACKGROUND DATA Patients with coccydynia who do not respond to conservative treatment will often profit from coccygectomy. Studies of results and complications vary considerably and often report on a limited number of patients. Methods. A total of 184 patients were operated with coccygectomy in our department and followed-up with questionnaires after a minimum of 1 year post-operatively. Treatment results were compared to their preoperative state, and any complications or reoperations were recorded and analyzed. Results. A total of 171 patients (93%) responded to final follow-up. The overall success rate was 71%, defined by patients being either completely well or much better at final follow-up. Furthermore, 89% off all patients would have consented to the operation if they had known the outcome in advance. The rate of post-operative infections was reduced from 10% to 2% by increasing the duration of prophylactic postoperative antibiotics from 24 to 48 hours (P = 0.018). CONCLUSION Coccygectomy, for patients where conservative measures have failed, seems to give acceptable levels of success and high levels of patient satisfaction. The main complication after this procedure is infection, and the risk can be somewhat reduced by using antibiotic prophylaxis for 48 hours after surgery. LEVEL OF EVIDENCE 4.
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König MA, Grifka J, Benditz A. A novel radiological classification for displaced os coccyx: the Benditz-König classification. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:10-17. [PMID: 34495391 DOI: 10.1007/s00586-021-06971-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 07/01/2021] [Accepted: 08/18/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Treatment of coccygodynia is still a challenging entity. Clear surgical selection criteria are still lacking. The aim of the investigation was to establish a novel radiological classification for surgical decision-making in coccygodynia cases. MATERIAL AND METHODS Retrospective analysis of standing and sitting X-rays of coccygodynia patients referred to a single centre from 2018 to 2020. The sacro-coccygeal angle (SCA), the intra-coccygeal angle (ICA) and the difference of the intervertebral disc height (∆IDH) were measured. All coccyges were distributed in subtypes and correlated with the patients' treatment. RESULTS In total, 138 patients (female/male: 103/35) with a mean age of 45.6 ± 15.4 years were included in the study. In total, 49 patients underwent coccygectomy. Four different subtypes of displaced coccyges were identified: Type I with a non-segmented coccyx, anterior pivot, increased SCA and ICA from standing to sitting, ∆IDH = 1.0 ± 1.5 mm. Type II with a multisegmented coccyx, anterior pivot, increased SCA and ICA standing/sitting, ∆IDH = 1.1 ± 1.6 mm. Type III showed a posterior pivoted coccyx, negative SCA and ICA, ∆IDH = 0.6 ± 1.6 mm. Type IV is characterized by an anterior-posterior dissociation of the tail bone with a positive SCA, and the ICA shifted from a posterior to an anterior orientation. ∆IDH was - 0.6 ± 1.8 mm. CONCLUSION The presented radiological classification could help to facilitate the surgical decision-making for patients with displaced os coccyx. In addition, lateral and sitting X-rays were easy to perform and did not need unnecessary ionizing radiation like in CT scans and were more cost-effective than MRI investigations. The subtypes III and especially IV were more likely leading to surgery.
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Affiliation(s)
- Matthias A König
- Department of Orthopedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany.
| | - Joachim Grifka
- Department of Orthopedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
| | - Achim Benditz
- Department of Orthopedic Surgery, Regensburg University Medical Center, Bad Abbach, Germany
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Sencan S, Yolcu G, Bilim S, Kenis-Coskun O, Gunduz OH. Comparison of treatment outcomes in chronic coccygodynia patients treated with ganglion impar blockade versus caudal epidural steroid injection: a prospective randomized comparison study. Korean J Pain 2022; 35:106-113. [PMID: 34966017 PMCID: PMC8728552 DOI: 10.3344/kjp.2022.35.1.106] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Coccygodynia is one of the chronic, refractory painful musculoskeletal disorders. Interventional procedures are applied to patients unresponsive to initial treatment in coccygodynia. This study aims to compare the treatment outcomes of ganglion impar block (GIB) and caudal epidural steroid injection (CESI) in patients with chronic coccygodynia. METHODS This study was a prospective randomized comparison study conducted between June 2019 and January 2021. Patients diagnosed with chronic coccygodynia were randomly divided into two groups: the GIB group and the CESI group. The severity of pain, presence of neuropathic pain, and quality of life were evaluated using the Numeric Rating Scale, Leeds Assessment of the Neuropathic Symptoms and Signs Scale, and Short Form-12 Health Survey (SF-12), respectively. RESULTS A total of 34 patients in each group were included in the final analyses. While there was a significant decrease in pain intensity in both groups in the 3-month follow-up, this decrease was more significant in the GIB group at the 3rd week. There was a significant improvement in the SF-12 physical score and the number of patients with neuropathic pain in both groups in the 3rd week, but this improvement was not observed in the 3rd month. CONCLUSIONS Although GIB may provide more pain relief in short term, both GIB and CESI are useful treatment methods in coccygodynia unresponsive to more conservative treatments.
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Affiliation(s)
- Savas Sencan
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Gunay Yolcu
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Serhad Bilim
- Pain Clinic, Adıyaman Education and Research Hospital, Adıyaman, Turkey
| | - Ozge Kenis-Coskun
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, Istanbul, Turkey
| | - Osman Hakan Gunduz
- Division of Pain Medicine, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Marmara University, Istanbul, Turkey
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Sagoo NS, Haider AS, Palmisciano P, Vannabouathong C, Gonzalez R, Chen AL, Lokesh N, Sharma N, Larsen K, Singh R, Mulpuri N, Rezzadeh K, Caldwell C, Tappen LA, Gill K, Vira S. Coccygectomy for refractory coccygodynia: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:176-189. [PMID: 34694498 DOI: 10.1007/s00586-021-07041-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/11/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We sought to systematically assess and summarize the available literature on outcomes following coccygectomy for refractory coccygodynia. METHODS PubMed, Scopus, and Cochrane Library databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data concerning patient demographics, validated patient reported outcome measures (PROMs) for pain relief, disability outcomes, complications, and reoperation rates were extracted and analyzed. RESULTS A total of 21 studies (18 retrospective and 3 prospective) were included in the quantitative analysis. A total of 826 patients (females = 75%) received coccygectomy (720 total and 106 partial) for refractory coccygodynia. Trauma was reported as the most common etiology of coccygodynia (56%; n = 375), followed by idiopathic causes (33%; n = 221). The pooled mean difference (MD) in pain scores from baseline on a 0-10 scale was 5.03 (95% confidence interval [CI]: 4.35 to 6.86) at a 6-12 month follow-up (FU); 5.02 (95% CI: 3.47 to 6.57) at > 12-36 months FU; and 5.41 (95% CI: 4.33 to 6.48) at > 36 months FU. The MCID threshold for pain relief was surpassed at each follow-up. Oswestry Disability Index scores significantly improved postoperatively, with a pooled MD from baseline of - 23.49 (95% CI: - 31.51 to - 15.46), surpassing the MCID threshold. The pooled incidence of complications following coccygectomy was 8% (95% CI: 5% to 12%), the most frequent of which were surgical site infections and wound dehiscence. The pooled incidence of reoperations was 3% (95% CI: 1% to 5%). CONCLUSION Coccygectomy represents a viable treatment option in patients with refractory coccygodynia.
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Affiliation(s)
- Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Ali S Haider
- Deparment of Neurosurgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma and Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Christopher Vannabouathong
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Roberto Gonzalez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Andrew L Chen
- Department of Orthopaedic Surgery, Texas Tech University School of Medicine, Lubbock, TX, USA
| | - Nidhish Lokesh
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Neha Sharma
- Roseman University of Health Sciences, South Jordan, UT, USA
| | - Kylan Larsen
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Ravinderjit Singh
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Neha Mulpuri
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Kevin Rezzadeh
- 6Department of Orthopaedic Surgery, Cedars-Sinai Orthopaedics, Los Angeles, CA, USA
| | - Christie Caldwell
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Lori A Tappen
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Kevin Gill
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA.
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13
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Milosevic S, Andersen GØ, Jensen MM, Rasmussen MM, Carreon L, Andersen MØ, Simony A. The efficacy of coccygectomy in patients with persistent coccydynia. Bone Joint J 2021; 103-B:542-546. [PMID: 33641429 DOI: 10.1302/0301-620x.103b3.bjj-2020-1045.r2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate the efficacy of coccygectomy in patients with persistent coccydynia and coccygeal instability. METHODS The Danish National Spine Registry, DaneSpine, was used to identify 134 consecutive patients who underwent surgery, performed by a single surgeon between 2011 and 2019. Routine demographic data, surgical variables, and patient-reported outcomes, including a visual analogue scale (VAS) (0 to 100) for pain, Oswestry Disability Index (ODI), EuroQol five-dimension questionnaire (EQ-5D), and the Physical Component Score (PCS) and Mental Component Score (MCS) of the 36-Item Short-Form Health Survey questionnaire (SF-36) were collected at baseline and one-year postoperatively. RESULTS A total of 112 (84%) patients with a minimum follow-up of one year had data available for analysis. Their mean age was 41.9 years, and 15 (13%) were males. At 12 months postoperatively, there were statistically significant improvements (p < 0.001) from baseline for the mean VAS for pain (70.99 to 35.34), EQ-5D (0.52 to 0.75), ODI (31.84 to 18.00), and SF-36 PCS (38.17 to 44.74). A total of 78 patients (70%) were satisfied with the outcome of treatment. CONCLUSION Patients with persistent coccydynia and coccygeal instability resistant to nonoperative treatment may benefit from coccygectomy. Cite this article: Bone Joint J 2021;103-B(3):542-546.
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Affiliation(s)
- Stefan Milosevic
- Cense-Spine, Department of Neurosurgery, Aarhus Universitetshospital, Aarhus N, Denmark.,Center for Spine Surgery & Research, Sygehus Lillebælt Middelfart Sygehus, Middelfart, Denmark
| | - Gustav Ø Andersen
- Cense-Spine, Department of Neurosurgery, Aarhus Universitetshospital, Aarhus N, Denmark.,Center for Spine Surgery & Research, Sygehus Lillebælt Middelfart Sygehus, Middelfart, Denmark
| | - Mads M Jensen
- Cense-Spine, Department of Neurosurgery, Aarhus Universitetshospital, Aarhus N, Denmark.,Center for Spine Surgery & Research, Sygehus Lillebælt Middelfart Sygehus, Middelfart, Denmark
| | - Mikkel M Rasmussen
- Cense-Spine, Department of Neurosurgery, Aarhus Universitetshospital, Aarhus N, Denmark
| | - Leah Carreon
- Center for Spine Surgery & Research, Sygehus Lillebælt Middelfart Sygehus, Middelfart, Denmark
| | - Mikkel Ø Andersen
- Center for Spine Surgery & Research, Sygehus Lillebælt Middelfart Sygehus, Middelfart, Denmark
| | - Ane Simony
- Center for Spine Surgery & Research, Sygehus Lillebælt Middelfart Sygehus, Middelfart, Denmark
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14
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Interventional Radiofrequency Treatment for the Sympathetic Nervous System: A Review Article. Pain Ther 2021; 10:115-141. [PMID: 33433856 PMCID: PMC8119558 DOI: 10.1007/s40122-020-00227-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/24/2020] [Indexed: 12/14/2022] Open
Abstract
Introduction Interventional techniques such as radiofrequency (RF) treatment can be used to interrupt pain signals transmitted through the sympathetic nervous system (SNS). RF treatments including the pulsed (PRF) and continuous (CRF) modalities show enhanced control over lesion size and enhanced ability to confirm accurate positioning compared to other interventional methods. PRF also acts to reduce the area of the lesion. In this article, we characterize the currently available evidence supporting the use and efficacy of RF treatments in sympathetically mediated pain (SMP) conditions. Study Design A comprehensive literature review. Methods A PubMed and Cochrane Library database search was performed for human studies applying RF treatment at sympathetic sites (sphenopalatine ganglion, stellate ganglion, cervical, thoracic, or lumbar sympathetic ganglia, celiac plexus, splanchnic nerves, superior hypogastric plexus, and ganglion impar) between January 1970 to May 2020. Data were extracted, summarized into tables, and qualitatively analyzed. Results PRF and CRF both show promise in relieving SMP conditions, such as complex regional pain syndrome (CRPS), pain in the perineal region, headache and facial pain, and oncologic and non-oncologic abdominal pain, in addition to other types of pain, with minimal complications. Furthermore, in most comparative studies, outcomes using RF treatments exceeded other interventional techniques, such as anesthetic block and chemical neurolysis. Conclusions RF treatments can be effective in carefully selected patients who are refractory to conservative management. However, further randomized controlled studies are needed prior to implementing it into common practice.
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15
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Finsen V, Kalstad A, Knobloch RG. The effect of injection therapy and operation of coccydynia on the schooling and physical activity of adolescent patients. Orthop Rev (Pavia) 2020; 12:8619. [PMID: 33312487 PMCID: PMC7726829 DOI: 10.4081/or.2020.8619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 06/20/2020] [Indexed: 11/22/2022] Open
Abstract
Pain while sitting is the most common complaint among patients with Coccydynia. In young patients this may seriously affect their schooling which usually involves long periods of sitting. We studied if this improved after either injection therapy or surgery. During a seven-year period 32 adolescents with a mean age of 15 (range: 11-17) years were treated in our department because of coccydynia. They were followed up with mailed questionnaires at a minimum of 12 months after treatment and 28 (88%) responded. Three were no longer attending school and were excluded. Of the remainder, 12 received only injection therapy while 13 were operated upon. Mean follow-up time was 36 (14-66) months. Eight reported absence from school during the month before treatment, but only one during the week before review (pÃ0.01). There was significant improvement in sitting during class and physical exercise at school and when engaging in general sports (pÃ0.01). We can not exclude that improvements would have occurred spontaneously, but this seems unlikely as symptoms had persisted for more than two years before treatment. We conclude that in juveniles, an additional benefit of treating coccydynia with corticosteroid injection or operative resection is that their ability to attend school and take part in sports improves significantly.
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Affiliation(s)
- Vilhjalmur Finsen
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim.,Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Rainer G Knobloch
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim
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16
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Coccygectomy for coccygodynia: a cohort study with a long-term follow-up of up to 29 years. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:1072-1076. [PMID: 33141347 DOI: 10.1007/s00586-020-06627-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/28/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
PURPOSE We aim to critically review the effectiveness and safety of coccygectomy with special regard to long-term outcomes. METHODS Coccygectomy was performed in our clinic in 38 patients between 1990 and 2019. All these patients (32 females vs. 6 males) have failed to respond to conservative treatment for at least 6 months prior to surgery. All patients were available for follow-up after mean 12,3 years (2 months to 29 years, 11 patients had a minimum FUP of 24 years). We evaluated all patients clinically and radiologically. RESULTS Nineteen patients reported traumatic and 17 patients reported idiopathic onset of their symptoms; one patient had clinical symptoms after childbirth and another patient had coccygodynia after extensive low back surgery. 36 of our 38 patients were free of pain at least 6 months after surgery and had good or excellent clinical results according to the VAS which improved from 6.37 (SD 1.08) preoperatively to 0.68 (SD 0.99) at the recent follow-up. Two patients showed an ODI > 22 at the recent follow-up (24 and 28) and 32 had an ODI equal or under 4. There was no statistical significant difference in terms of clinical outcome between the different radiological types of the coccyx. Postoperative complications were rare: 1 superficial infection and one re-operation 6 months after initial surgery due to an pre-existing exostosis which had not been removed at the index surgery; no neurological complications and no major bleeding occurred. No patient had recurrent onset of coccygodynia. 37 out of 38 patients would have coccygectomy again. CONCLUSIONS Coccygectomy is a safe treatment option in patients with coccygodynia and shows excellent long-term results. We recommend to perform coccygectomy if patients fail to respond to conservative treatment for 6 months. LEVEL OF EVIDENCE IV.
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17
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Coccydynia: Diagnostic and Management Guidance. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Coccygectomy for refractory coccydynia: A single-center experience. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2020. [DOI: 10.1016/j.inat.2020.100735] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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19
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Abstract
Aims To determine if the results of treatment of adolescents with coccydynia are similar to those found in adults. Adult patients with coccydynia may benefit from injection therapy or operative treatment. There is little data evaluating treatment results in adolescents. We have treated adolescent patients similarly to adults and compared the outcomes. Methods Overall, 32 adolescents with coccydynia were treated at our institution during a seven-year period; 28 responded to final follow-up questionnaires after a minimum of one year, 14 had been treated with only injection therapy, and 14 had been operated with coccygectomy. We collected data with regards to pain while sitting, leaning forward, rising from a sitting position, during defecation, while walking or jogging, and while travelling in trains, planes, or automobiles. Pain at follow-up was registered on a numeric pain scale. Each adolescent was then matched to adult patients, and results compared in a case control fashion. The treatment was considered successful if respondents were either completely well or much better at final follow-up after one to seven years. Results Out of the 28 treated adolescents, 14 were regarded as successfully treated. Seven were somewhat better, and the remaining seven were unchanged. In the adult control group the corresponding number was 15 successfully treated, eight patients were somewhat better, and five were unchanged. Six of the 14 successfully treated adolescents had been operated. There were no significant differences between the groups in the various registered domains, or on numeric pain scale. Conclusion Treatment results in adolescent patients seem similar to those in adults. The long-term success rate of injection therapy is low. In case of injection treatment failure, operation may be considered, also in adolescents.
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Affiliation(s)
- Ante Matti Kalstad
- Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway.,Norwegian Armed Forces Joint Medical Services, Trondheim, Norway.,Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
| | | | - Vilhjalmur Finsen
- Department of Orthopedic Surgery, St. Olavs University Hospital, Trondheim, Norway.,Faculty of Medicine, Norwegian University of Science and Technology, NTNU, Trondheim, Norway
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20
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Sagir O, Demir HF, Ugun F, Atik B. Retrospective evaluation of pain in patients with coccydynia who underwent impar ganglion block. BMC Anesthesiol 2020; 20:110. [PMID: 32393277 PMCID: PMC7212553 DOI: 10.1186/s12871-020-01034-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/06/2020] [Indexed: 12/03/2022] Open
Abstract
Background We aimed to evaluate pain scores one year after impar ganglion block in patients with coccydynia who did not benefit from conservative treatment. Methods The medical records of 29 patients with coccydynia were reviewed. Patients who were referred to the algology clinic and underwent impar ganglion blocks were retrospectively evaluated. Demographic data, time to the onset of pain, causes of pain, X-ray findings, administered invasive procedures, and visual analog scale (pain) scores were recorded. Results A total of 29 patients were included in the study, 10 males (34%) and 19 females (66%). The average age and body mass index were 53.45 ± 9.6 and 29.55 ± 4.21 respectively. In 21 patients, the onset of pain was associated with trauma. Nineteen patients (65.5%) had anterior coccygeal angulation. The average visual analog scale score before undergoing an impar ganglion block was 7.4 ± 1. After the procedure, the scores at < 3 months, 3–6 months and 6 months-1 year follow-up intervals were significantly lower (p < 0.05). Furthermore, visual analog scale scores at the 3–6 months and 6 months-1 year periods were significantly lower in patients who received diagnostic blocks plus pulse radiofrequency thermocoagulation than in patients who underwent a diagnostic block only. Conclusions The impar ganglion block provides effective analgesia without complications in patients with coccydynia. Pulse radiofrequency thermocoagulation combined with a diagnostic block prolongs the analgesic effect of the procedure.
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Affiliation(s)
- Ozlem Sagir
- Department of Anesthesiology, Balıkesir University Health Application and Research Hospital, 10100, Balikesir, Turkey.
| | - Hafize Fisun Demir
- Department of Anesthesiology, Balıkesir University Health Application and Research Hospital, 10100, Balikesir, Turkey
| | - Fatih Ugun
- Department of Anesthesiology, Balıkesir University Health Application and Research Hospital, 10100, Balikesir, Turkey
| | - Bulent Atik
- Department of Anesthesiology, Balıkesir University Health Application and Research Hospital, 10100, Balikesir, Turkey
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21
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Benditz A, König MA. [Therapy-resistant coccygodynia should no longer be considered a myth : The surgical approach]. DER ORTHOPADE 2018; 48:92-95. [PMID: 30535765 DOI: 10.1007/s00132-018-03665-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Coccygodynia is still often considered a mystery, and many patients are not taken seriously with their problems and pain. CASE A 51-year-old thin lady presented at our clinic with lifelong, persistent low back pain. The clinical examination indicated suspicion of coccygodynia. A functional X‑ray revealed a hypermobile os coccygeum with dorsal tilt. After a total coccygectomy via a y-shaped approach, she was completely pain free at the 12 months follow-up examination. No surgical site infection occurred in this period.
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Affiliation(s)
- A Benditz
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland.
| | - M A König
- Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland
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22
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Ganglion Impar block improves neuropathic pain in coccygodynia: A preliminary report. Neurol Neurochir Pol 2018; 52:612-617. [DOI: 10.1016/j.pjnns.2018.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 07/20/2018] [Accepted: 08/15/2018] [Indexed: 11/21/2022]
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