1
|
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.
Collapse
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
| | | |
Collapse
|
2
|
Şah V, Elasan S, Kaplan Ş. Comparative effects of radial and focused extracorporeal shock wave therapies in coccydynia. Turk J Phys Med Rehabil 2023; 69:97-104. [PMID: 37201007 PMCID: PMC10186009 DOI: 10.5606/tftrd.2023.10371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/18/2022] [Indexed: 05/20/2023] Open
Abstract
Objectives This study was conducted to compare the effects of radial and focused extracorporeal shock wave therapy (ESWT) in patients with coccydynia. Patients and methods In this prospective randomized double-blind study conducted between March 2021 and October 2021, 60 patients with coccydynia (50 males, 10 females; mean age: 35.9±12.0 years, range 18 to 65 years) were randomized into three groups (n=20) according to different wave types of ESWT: focused, radial, and sham. The Visual Analog Scale (VAS) was used for pain assessment, and the Oswestry Disability Index (ODI) was used for functional assessment in all patients before the treatment (baseline), after the completion of four sessions of treatment (fourth week), one month after the end of the treatment (eighth week), and three months after the end of the treatment (16th week). Results The mean body mass index of the participants was 26.2±3.0. Compared to baseline, the VAS scores at four weeks were reduced only in the radial ESWT group (p<0.05). Compared to baseline, the VAS and ODI scores at eight and 16 weeks were significantly reduced in both the focused and radial ESWT groups (p<0.05 for all). The radial ESWT group was significantly superior to the focused ESWT group in the comparisons between the groups at four weeks in the VAS values and at 16 weeks in the ODI scores (p<0.05 for all). Conclusion Radial and focused ESWT are both effective in treating coccydynia compared to sham ESWT. However, radial ESWT may be more effective in the treatment of coccydynia.
Collapse
Affiliation(s)
- Volkan Şah
- Department of Sports Medicine, Yüzüncü Yıl University School of Medicine, Van, Türkiye
| | - Sadi Elasan
- Department of Biostatistics, Yüzüncü Yıl University School of Medicine, Van, Türkiye
| | - Şeyhmus Kaplan
- Department of Sports Medicine, Yüzüncü Yıl University School of Medicine, Van, Türkiye
| |
Collapse
|
3
|
Muacevic A, Adler JR, Kumar S. Ganglion Impar Block: A Magic Bullet to Fix Idiopathic Coccygodynia. Cureus 2023; 15:e33911. [PMID: 36819309 PMCID: PMC9937633 DOI: 10.7759/cureus.33911] [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] [Accepted: 01/15/2023] [Indexed: 01/19/2023] Open
Abstract
Coccygodynia (coccydynia) is a painful condition of the perineum in the region of the tailbone or coccyx, aggravated by sitting on hard surfaces. It is frequently associated with injuries to the coccyx following direct trauma. Nevertheless, idiopathic coccygodynia without antecedent trauma history is not uncommon. Most of these patients respond to anti-inflammatory medications and physical therapy. Those who are unresponsive may require additional intervention for pain relief. Blockade of ganglion impar, the terminal end of the pelvic sympathetic chain, can dramatically alleviate the pain in patients suffering from coccygodynia. In the current case series, four patients in the age range of 21 to 69 years suffering from chronic idiopathic coccygodynia (female: male ratio of 1:1) were treated with ganglion impar block. All four patients received a course of medical management, and two of the patients additionally received local infiltration of the coccyx before ganglion impar block administration. The block was performed with fluoroscopy guidance by either the trans-sacrococcygeal joint approach or the intra-coccygeal joint approach. The pre-intervention average numeric rating pain score (NRS) was 7.5. After a single ganglion impar block intervention, all four patients experienced complete pain relief (NRS=0). No patients required a repeat injection, and all were pain-free for the entire one-year follow-up period.
Collapse
|
4
|
Andersen GØ, Milosevic S, Jensen MM, Andersen MØ, Simony A, Rasmussen MM, Carreon L. Coccydynia-The Efficacy of Available Treatment Options: A Systematic Review. Global Spine J 2022; 12:1611-1623. [PMID: 34927468 PMCID: PMC9393997 DOI: 10.1177/21925682211065389] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
STUDY DESIGN Systematic Review. OBJECTIVE To evaluate the efficacy of available treatment options for patients with persistent coccydynia through a systematic review. METHODS Original peer-reviewed publications on treatment for coccydynia were identified using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines by performing a literature search of relevant databases, from their inception to January 17, 2020, combined with other sources. Data on extracted treatment outcome was pooled based on treatment categories to allow for meta-analysis. All outcomes relevant to the treatment efficacy of coccydynia were extracted. No single measure of outcome was consistently present among the included studies. Numeric Rating Scale, (NRS, 0-10) for pain was used as the primary outcome measure. Studies with treatment outcome on adult patients with chronic primary coccydynia were considered eligible. RESULTS A total of 1980 patients across 64 studies were identified: five randomized controlled trials, one experimental study, one quasi-experimental study, 11 prospective observational studies, 45 retrospective studies and unpublished data from the DaneSpine registry. The greatest improvement in pain was achieved by patients who underwent radiofrequency therapy (RFT, mean Visual Analog Scale (VAS) decreased by 5.11 cm). A similar mean improvement was achieved from Extracorporeal Shockwave Therapy (ESWT, 5.06), Coccygectomy (4.86) and Injection (4.22). Although improved, the mean change was less for those who received Ganglion block (2.98), Stretching/Manipulation (2.19) and Conservative/Usual Care (1.69). CONCLUSION This study highlights the progressive nature of treatment for coccydynia, starting with noninvasive methods before considering coccygectomy. Non-surgical management provides pain relief for many patients. Coccygectomy is by far the most thoroughly investigated treatment option and may be beneficial for refractory cases. Future randomized controlled trials should be conducted with an aim to compare the efficacy of interventional therapies amongst each other and to coccygectomy.
Collapse
Affiliation(s)
- Gustav Ø. Andersen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark,Gustav Ø. Andersen, Department of Neurosurgery, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, Aarhus 8200 Denmark.
| | - Stefan Milosevic
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mads M. Jensen
- Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark
| | - Mikkel Ø. Andersen
- Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej, Denmark
| | - Ane Simony
- Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej, Denmark
| | | | - Leah Carreon
- Center for Spine Surgery & Research, Middelfart Hospital, Østre Hougvej, Denmark,Norton Leatherman Spine Center, Louisville, KY, USA
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Ibrahim ME, Awadalla MA, Omar AS, al-Shatouri M. Ultrasound-guided caudal epidural steroid injection in chronic radicular low back pain: short-term electrophysiologic benefits. BJR Open 2020; 2:20190006. [PMID: 33178957 PMCID: PMC7594900 DOI: 10.1259/bjro.20190006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 10/25/2019] [Accepted: 12/16/2019] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the short-term efficacy of ultrasound-guided caudal epidural steroid injections (ESIs) in improving pain, and nerve function as measured by electrophysiological testing in chronic radicular low back pain. METHODS Patients diagnosed with chronic radicular low back pain were randomized into one of two groups. The injection group (n = 20) underwent a single ultrasound-guided Caudal ESI of 1 ml of 40 mg ml-1 Triamcinolone Acetonide (Kenacort-A), with local anesthetic. The control group (n = 20) underwent a 12-session physiotherapy program. Both groups were evaluated before and 2 weeks after the intervention using visual analog scale for pain and electrophysiological testing comprising peroneal and tibial terminal motor latencies and F-response latencies and chronodispersion. RESULTS Both groups showed significant pain reduction on the visual analog scale after the intervention. The injection group showed a significant reduction in F wave chronodispersion post-treatment (<0.01). In the control group, there were no significant differences in F wave parameters pre- and post-treatment (p > 0.05). CONCLUSION Caudal ESIs were shown to provide short-term improvement of nerve function as evident by improvement in the electrophysiological parameters sensitive to radiculopathy. It was found to be superior to standard physical therapy in this regard. ADVANCES IN KNOWLEDGE This work shows a novel electrophysiologic evidence of the short-term efficacy ultrasound-guided caudal ESI.
Collapse
Affiliation(s)
- Maha Emad Ibrahim
- Lecturer of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University. PhD in Physical Medicine, Rheumatology and Rehabilitation, Ismailia, Egypt
| | - Magdy Ahmed Awadalla
- Professor of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University. PD in Physical Medicine, Rheumatology and Rehabilitation, Ismailia, Egypt
| | - Aziza Sayed Omar
- Professor of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University. PD in Physical Medicine, Rheumatology and Rehabilitation, Ismailia, Egypt
| | - Mohammad al-Shatouri
- Associate professor of Radiology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Coccygodynia is pain within the coccyx area. The diagnosis is made clinically with symptoms of pain in the coccyx region and worsening pain in sitting position. The initial treatment is conservative therapy. For patients who do not respond to conservative therapies, there are further interventions available. This includes local injection of local anesthetics and steroids, neurolysis of sacral nerve roots, caudal epidural block, pulse radiofrequency (PRF), intra-rectal massage and manipulation, ganglion impar block, levator ani massage and stretching, coccyx manipulation, and coccygectomy. The purpose of this review is to evaluate the efficacies of these interventions in the treatment of coccygodynia. RECENT FINDINGS Literature search was performed with the keywords including coccygodynia, treatment, and coccygectomy, on PubMed and Google Scholar between August 2012 and August 2017. Thirteen studies with patients age 18 and over who underwent treatments for coccygodynia were selected for analysis. These treatments include conservative therapies (physical therapy and capsaicin patch), interventional techniques (local injections with steroids and local anesthetic, pulsed radiofrequency ablation of ganglion impar, extracorporeal shock wave therapy), and surgical techniques (complete and partial coccygectomies). The results from these studies demonstrated that most patients had significant pain relief with these techniques. Our literature review demonstrated various interventions including coccygectomy can be effective in the treatment of coccygodynia refractory to conservative therapies. There is a growing body of clinical evidence to support that coccygectomy is an effective treatment for patients with debilitating pain who had failed interventional therapies. Further randomized control studies should be conducted to examine duration of pain relief after coccygectomy and associated surgical complications.
Collapse
Affiliation(s)
- Yasmin Elkhashab
- Department of Anesthesiology, Jefferson Pain Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite T-150, Philadelphia, PA, 19107, USA
| | - Andrew Ng
- Department of Anesthesiology, Jefferson Pain Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite T-150, Philadelphia, PA, 19107, USA.
| |
Collapse
|