1
|
Romsom J, Leenders MWH. Iatrogenic rectal perforation after coccygeal radiofrequency ablation. BMJ Case Rep 2024; 17:e259493. [PMID: 38839400 DOI: 10.1136/bcr-2023-259493] [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] [Indexed: 06/07/2024] Open
Abstract
Coccygodynia (pain of the coccygeal bone) can be treated locally with anti-inflammatory drugs, local steroid injections, surgical removal of the coccyx and, more recently, with radiofrequency thermal ablation. Complications, such as perforation of the colon, can occur as a consequence of the close relationship between the rectum and the sacrococcyx and with the heat from the thermal ablation expanding to the surrounding tissue causing delayed damage with severe consequences. The treatment of this complication requires the combined effort of the gastrointestinal surgeon as well as a gastroenterologist. In this case report, we describe the treatment of this complication and the clinical course after a perforation of the rectum due to thermal ablation of the coccyx to treat long-standing coccygodynia.
Collapse
Affiliation(s)
- Jesse Romsom
- Surgery, HagaZiekenhuis, Den Haag, The Netherlands
| | | |
Collapse
|
2
|
Daily D, Bridges J, Mo WB, Mo AZ, Massey PA, Zhang AS. Coccydynia: A Review of Anatomy, Causes, Diagnosis, and Treatment. JBJS Rev 2024; 12:01874474-202405000-00004. [PMID: 38709859 DOI: 10.2106/jbjs.rvw.24.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
» Coccydynia is a painful condition affecting many patients at the terminal caudal end of the spine.» An understanding of coccyx anatomy and variations of morphology is necessary for proper diagnosis. A multifactorial etiology for pain may be responsible for this clinical entity.» Several treatment options exist. Successful outcomes for patients depend on individual patient characteristics and the etiology of pain.
Collapse
Affiliation(s)
- Drayton Daily
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - James Bridges
- School of Medicine, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - William B Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Andrew Z Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Patrick Allan Massey
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - Andrew S Zhang
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| |
Collapse
|
3
|
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
|
4
|
Santiago N, Monaco BA, Santos Piedade G, Jagid J, Cordeiro JG. Navigated Dorsal Root Ganglion Stimulation (DRGS) for the Treatment of Chronic Refractory Coccygodynia: A Case Report. Cureus 2023; 15:e41663. [PMID: 37575765 PMCID: PMC10412402 DOI: 10.7759/cureus.41663] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2023] [Indexed: 08/15/2023] Open
Abstract
Sacral stimulation is a well-established therapy for urologic neuromodulation. After the advent of dorsal root ganglion (DRG) stimulation, pain surgeons have started to reach this target mostly for pelvic and sacral pain. For those without good surgical experience, sacral foramen puncture, especially S3 and S4, can be a challenge, due to its entry angle and limited C-arm image resolution. In this report, we describe a new technique to utilize sacral navigation using the O-arm approach to guide DRG stimulation implants. We discuss a case of a 53-year-old male patient with refractory coccygodynia, who underwent sacral DRG implantation using neuronavigation. Punctures could be done without the need for multiple attempts to reach the foramen in this patient.
Collapse
Affiliation(s)
- Natally Santiago
- Neurological Surgery, Beneficência Portuguesa de São Paulo, São Paulo, BRA
| | - Bernardo A Monaco
- Neurological Surgery, University of Miami, Miami, USA
- Neurological Surgery, CDF - Clinica de Dor e Funcional, São Paulo, BRA
- Neurological Surgery, University of Sao Paulo, São Paulo, BRA
| | | | | | | |
Collapse
|
5
|
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
|
6
|
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.
Collapse
|
7
|
Roa JA, White S, Barthélemy EJ, Jenkins A, Margetis K. Minimally invasive endoscopic approach to perform complete coccygectomy in patients with chronic refractory coccydynia: illustrative case. JOURNAL OF NEUROSURGERY: CASE LESSONS 2022; 3:CASE21533. [PMID: 36130572 PMCID: PMC9379649 DOI: 10.3171/case21533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coccydynia refers to debilitating pain in the coccygeal region of the spine. Treatment strategies range from conservative measures (e.g., ergonomic adaptations, physical therapy, nerve block injections) to partial or complete removal of the coccyx (coccygectomy). Because the surgical intervention is situated in a high-pressure location close to the anus, a possible complication is the formation of sacral pressure ulcers and infection at the incision site. OBSERVATIONS In this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia. LESSONS Although this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy.
Collapse
Affiliation(s)
- Jorge A. Roa
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah White
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina; and
| | - Ernest J. Barthélemy
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California
| | - Arthur Jenkins
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Konstantinos Margetis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
8
|
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
|
9
|
Choudhary R, Kunal K, Kumar D, Nagaraju V, Verma S. Improvement in Pain Following Ganglion Impar Blocks and Radiofrequency Ablation in Coccygodynia Patients: A Systematic Review. Rev Bras Ortop 2021; 56:558-566. [PMID: 34733426 PMCID: PMC8558944 DOI: 10.1055/s-0041-1735829] [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: 12/27/2020] [Accepted: 04/07/2021] [Indexed: 10/26/2022] Open
Abstract
Nearly 90% of cases of coccydynia can be managed with conservative medical treatment; the remaining 10% need other invasive modalities for pain relief, such as ganglion impar block (GIB) or radiofrequency ablation (RFA) of the ganglion impar. A systematic research was conducted of PubMed, MEDLINE, and Google Scholar to identify studies reporting pain relief in terms of visual analogue scale (VAS), or its counterparts, following GIB or RFA in coccydynia patients with the purpose to determine the efficacy of GIB and RFA of the ganglion impar in controlling pain in coccydynia patients. Seven studies were delineated, with a total of 189 patients (104 in GIB group and 85 in RFA group). In the GIB group, the mean VAS improved from 7.83 at baseline to 3.11 in the short-term follow-up, 3.55 in the intermediate-term follow-up, and 4.71 in the long-term follow-up. In the RFA group, the mean VAS improved from 6.92 at baseline to 4.25 in the short-term follow-up, and 4.04 in the long-term follow-up. In the GIB group, a 13.92% failure rate (11/79) and a 2.88% complication rate (3/104) were reported, while in the RFA group, a 14.08% failure rate (10/71) and no complications (0%) were reported. Total success rate was > 85% with either modality. Ganglion impar block and RFA of the ganglion impar are reliable and probably excellent methods of pain control in coccydynia patients not responding to conservative medical treatment. However, a demarcation between responders, non-responders, and late non-responders should be considered, and larger studies with a longer follow-up (> 1 year) are needed.
Collapse
Affiliation(s)
- Ranjeet Choudhary
- Department of Orthopaedics, Instituto de Ciências Médicas da Índia (AIIMS), Raipur, Chhattisgarh, Índia
| | - Kishor Kunal
- Department of Orthopaedics, Instituto de Ciências Médicas da Índia (AIIMS), Jodhpur, Rajasthan, Índia
| | - Dhirendra Kumar
- Department of Orthopaedics, Instituto de Ciências Médicas da Índia (AIIMS), Jodhpur, Rajasthan, Índia
| | - Venishetty Nagaraju
- Department of Orthopaedics, Instituto de Ciências Médicas da Índia (AIIMS), Raipur, Chhattisgarh, Índia
| | - Shilp Verma
- Department of Orthopaedics, Instituto de Ciências Médicas da Índia (AIIMS), Raipur, Chhattisgarh, Índia
| |
Collapse
|
10
|
Is this coccyx fractured, or is it a normal variant? A cohort study. JOURNAL OF SURGERY AND MEDICINE 2021. [DOI: 10.28982/josam.839793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
11
|
Gonnade N, Mehta N, Khera PS, Kumar D, Rajagopal R, Sharma PK. Ganglion impar block in patients with chronic coccydynia. Indian J Radiol Imaging 2021; 27:324-328. [PMID: 29089683 PMCID: PMC5644328 DOI: 10.4103/ijri.ijri_294_16] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction: Coccydynia refers to pain in the terminal segment of the spinecaused by abnormal sitting and standing posture. Coccydynia is usually managed conservatively, however in nonresponsive patients, ganglion impar block is used as a good alternate modality for pain relief. This article studies the effect of ganglion impar block in coccydynia patients who were not relieved by conservative management. Materials and Methods: The study was carried out at the pain clinic in the departments of Physical Medicine and Rehabilitation and Radiology in a tertiary centre in India. It was a prospective hospital-based study, in which 35 patients with coccydynia were considered for fluoroscopy-guided trans-sacro-coccygeal ganglion impar block. The outcome assessment was done using Numerical Rating Scale (NRS) and Oswestry Disability Index (ODI) scores for a follow-up period of 6 months. Of the 35 patients, 4 were lost to follow-up. Analysis was done usingthe data from the remaining 31 patients. Results: The mean age of the patients suffering from chronic coccydynia was 42.9 ± 8.39 years, and patients' age range was 28–57 years. The mean score of NRS and ODI before the procedure was 7.90 ± 0.16 and 48.97 ± 1.05, respectively. The interquartile range (IQR) of NRS score remained almost unchanged during pre and postprocedure, however, IQR of ODI varied during the pre and post procedural events. The NRS and ODI scores immediately after the procedure decreased drastically showing significant pain relief in patients, and the difference of scores till the end of study was statistically significant. Conclusion: This study recommends the trans-sacro-coccygeal “needle inside needle” technique for local anesthetic block of the ganglion impar for pain relief in patients with coccydynia. This should be integrated with rehabilitative measures including ergonomical modification for prolonging pain free period.
Collapse
Affiliation(s)
- Nitesh Gonnade
- Department of Physical Medicine and Rehabilitation, AIIMS, Jodhpur, Rajasthan, India
| | - Neeraj Mehta
- Department of Diagnostic and Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India
| | | | - Dewesh Kumar
- Department of Community and Family Medicine, AIIMS, Jodhpur, Rajasthan, India
| | - Rengarajan Rajagopal
- Department of Diagnostic and Interventional Radiology, AIIMS, Jodhpur, Rajasthan, India
| | | |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Coccydynia-A comprehensive review on etiology, radiological features and management options. J Clin Orthop Trauma 2021; 12:123-129. [PMID: 33716437 PMCID: PMC7920198 DOI: 10.1016/j.jcot.2020.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/10/2020] [Accepted: 09/20/2020] [Indexed: 11/20/2022] Open
Abstract
Coccydynia is a disabling condition characterized by pain in the coccyx region of the spine. The first description of the disease was given in as early as 1859. Since then a number of theories have been proposed by various researchers to explain the pathogenesis of the disease. Treatment options for coccydynia include ergonomic adaptation, manual therapy, injections and surgery. Despite being identified as a disease as early as 18th century, several uncertainties with respect to the origin of pain, predisposing factors and treatment outcomes of a wide range of treatment options persist till date. The current narrative review presents various aspects of the disease including pathoanatomy, clinical presentation, radiological features and management options for the disease.
Collapse
|
14
|
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.
Collapse
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
| |
Collapse
|
15
|
Abstract
Aims We aimed to establish the short- and long-term efficacy of corticosteroid injection for coccydynia, and to determine if betamethasone or triamcinolone has the best effect. Methods During 2009 to 2016, we treated 277 patients with chronic coccydynia with either one 6 mg betamethasone or one 20 mg triamcinolone cortisone injection. A susequent injection was given to 62 (26%) of the patients. All were reviewed three to four months after injection, and 241 replied to a questionnaire a mean of 36 months (12 to 88) after the last injection. No pain at the early review was considered early success. When the patient had not been subsequently operated on, and indicated on the questionnaire that they were either well or much better, it was considered a long-term success. Results At the three- to four-month review, 22 (9%) reported that they had no pain. The long-term success of one injection was 15% and rose to 29% after a second injection. Logistic regression tests showed that both early success (odds ratio (OR) 5.5, 95% confidence interval (CI) 2.1 to 14.4; p = 0.001) and late success (OR 3.7, 95% CI 1.7 to 8.3; p = 0.001) was greater with triamcinolone than with betamethasone. Late success was greater for patients with symptoms for less than 12 months (OR 3.0, 95% CI 1.4 to 6.7; p = 0.006). We saw no complications of the injections. Conclusion We conclude that the effect of corticosteroid injection for coccygodynia is moderate, possibly because we used modest doses of the drugs. Even so, they seem worthwhile as they are easily and quickly performed, and complications are rare. If the choice is between injections of betamethasone or triamcinolone, the latter should be selected. Cite this article: Bone Joint Open 2020;1-11:709–714.
Collapse
Affiliation(s)
- Vilhjalmur Finsen
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway.,Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ante M Kalstad
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway.,Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Norwegian Armed Forces Joint Medical Services, Trondheim, Norway
| | - Rainer G Knobloch
- Department of Orthopaedic Surgery, St. Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
16
|
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]
|
17
|
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.
Collapse
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
| |
Collapse
|
18
|
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.
Collapse
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
| |
Collapse
|
19
|
Sandrasegaram N, Gupta R, Baloch M. Diagnosis and management of sacrococcygeal pain. BJA Educ 2020; 20:74-79. [DOI: 10.1016/j.bjae.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2019] [Indexed: 10/25/2022] Open
|
20
|
Sussman WI, Jerome MA, Foster L. Platelet-rich plasma for the treatment of coccydynia: a case report and review of regenerative medicine for coccydynia. Regen Med 2020; 14:1151-1154. [PMID: 31960759 DOI: 10.2217/rme-2019-0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe the successful treatment of coccydynia using ultrasound-guided injection of platelet-rich plasma. Setting: Outpatient orthopedic practice. Patient: 17-year-old female with BMI of 42.6. Case description: The patient presented with 6 months of nontraumatic coccygeal pain exacerbated by sitting. Physical exam was significant for point-tenderness over the sacral hiatus and coccyx. A corticosteroid injection around the sacrococcygeal ligament was administered with immediate resolution of her pain following the injection with the anesthetic. The patient reported significant pain relief for 1 week. The superficial sacrococcygeal ligament was then treated with a platelet-rich plasma injection under US guidance. Results: The patient reported a 70% improvement in pain and sitting tolerance at 6 weeks. By 6 months post injection, her pain was 100% resolved, and she remained pain free at the 12-month follow-up. Conclusion: Platelet-rich plasma may be considered as a treatment option in patients with refractory coccydynia.
Collapse
Affiliation(s)
- Walter I Sussman
- Department of Physical Medicine & Rehabilitation, Tufts University, Boston, MA 02111, USA.,Orthopedic Care Physician Network, N Easton, MA 02356, USA
| | - Mairin A Jerome
- Department of Rehabilitation Medicine, Emory University, Atlanta, GA 30322, USA
| | - Lisa Foster
- Department of Orthopaedics, Emory University, Johns Creek, GA 30097, USA
| |
Collapse
|
21
|
Abdel-Aal NM, Elgohary HM, Soliman ES, Waked IS. Effects of kinesiotaping and exercise program on patients with obesity-induced coccydynia: a randomized, double-blinded, sham-controlled clinical trial. Clin Rehabil 2020; 34:471-479. [PMID: 31918574 DOI: 10.1177/0269215519897414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the effect of kinesiotaping and a designed exercise program versus sham kinesiotaping and the same exercise program on pain, range of motion, and activities of daily living in obese patients suffering from coccydynia. DESIGN A double-blinded, randomized, sham-controlled trial. SETTING Outpatient, Cairo University hospitals. PARTICIPANTS Sixty patients with coccydynia randomized equally into kinesiotape plus exercise and sham kinesiotape plus exercise groups. INTERVENTION The kinesiotape was worn for three days and replaced for three weeks. Each patient practiced exercises for three weeks. OUTCOME MEASURES All patients were examined by visual analogue scale (VAS) for rating pain, Modified Modified Schober Test (MMST), and Oswestry Disability Index (ODI). All outcomes were measured at baseline, three weeks postintervention, and four weeks follow-up. RESULTS There were no statistically significant differences between groups at baseline (P < 0.05), but there were statistically significant differences between groups for pain score, MMST, and ODI at post and follow-up data in favor of the kinesiotape group (P < 0.001). For the three weeks postintervention, mean (SD) for pain score, MMST, and ODI was 33.07 ± 3.8, 6.6 ± 0.7, and 8.7 ± 2.1 in the study group and 39.9 ± 4.7, 5.8 ± 1.4, and 14.4 ± 2.7 in the control group, respectively. For the four weeks follow-up, mean (SD) for pain score, MMST, and ODI was 32.2 ± 3.4, 7.13 ± 0.6, and 7.2 ± 1.8 in the study group and 40.9 ± 4.4, 6.6 ± 0.75, and 13 ± 2 in the control group, respectively. CONCLUSION Experimental kinesiotape intervention and exercise program provided significant improvements in pain, range of motion, and disability. It is suggested as an adjunctive therapy in treating obese patients with coccydynia.
Collapse
Affiliation(s)
- Nabil Mahmoud Abdel-Aal
- Department of Physical Therapy for Basic Sciences, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Hany Mohamed Elgohary
- Department of physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Elsadat Saad Soliman
- Department of Physical Therapy for Musculoskeletal Disorders and Its Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | - Intsar Salem Waked
- Department of physical Therapy for Surgery, Faculty of Physical Therapy, Cairo University, Giza, Egypt
| |
Collapse
|
22
|
Chen Y, Huang-Lionnet JHY, Cohen SP. Radiofrequency Ablation in Coccydynia: A Case Series and Comprehensive, Evidence-Based Review. PAIN MEDICINE 2018; 18:1111-1130. [PMID: 28034983 DOI: 10.1093/pm/pnw268] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objectives Coccydynia is a condition with a multitude of different causes, characterized by ill-defined management. There are multiple prospective studies, including several controlled trials, that have evaluated conservative therapies. Additionally, a plethora of observational studies have assessed coccygectomy, but few studies have reported results for nonsurgical interventional procedures. In this report, we describe the treatment results of 12 patients who received conventional or pulsed radiofrequency for coccydynia and systematically review the literature on management. Methods We performed a retrospective data analysis evaluating patients who underwent pulsed or conventional radiofrequency treatment at Johns Hopkins Hospital and Walter Reed National Military Medical Center. A comprehensive literature review was also performed to contextualize these results. Results The mean age of patients treated was 50.25 years (SD = 11.20 years, range = 32-72 years), with the mean duration of symptoms being 3.6 years (SD = 3.36 years, range 1-10 years). There were 10 males and two females in this cohort. Among patients who received radiofrequency treatment, the average benefit was 55.5% pain relief (SD = 30.33%, range = 0-100%). Those who underwent conventional (vs pulsed radiofrequency) and who received prognostic blocks were more likely to experience a positive outcome. There were two cases of neuritis, which resolved spontaneously after several weeks. Conclusions Radiofrequency ablation of the sacrococcygeal nerves may serve as a useful treatment option for patients with coccydynia who have failed more conservative measures. Further research into this therapeutic approach and its benefit for coccydynia should incorporate a control group for comparison.
Collapse
Affiliation(s)
- Yian Chen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Julie H Y Huang-Lionnet
- Department of Anesthesiology and Interventional Pain Medicine, Greenwich Anesthesiology Associates, Greenwich Hospital, Yale University, New Haven, Connecticut
| | - Steven P Cohen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.,Neurology and Physical Medicine & Rehabilitation, Departments of Anesthesiology and Physical Medicine and Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| |
Collapse
|
23
|
Origo D, Tarantino A, Nonis A, Vismara L. Osteopathic manipulative treatment in chronic coccydynia: A case series. J Bodyw Mov Ther 2018; 22:261-265. [DOI: 10.1016/j.jbmt.2017.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
24
|
Current Treatments for Coccydynia. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0167-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
25
|
Coccygodynia review: coccygectomy case series. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:961-965. [PMID: 28386714 DOI: 10.1007/s00590-017-1947-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 04/01/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Coccygodynia is a pain of the coccyx that is typically exaggerated by pressure. Management includes anti-inflammatory medications, physiotherapy, and coccyx manipulation. Coccygectomy is the surgical approach for treating coccygodynia when the conservative management fails. Generally, coccygectomy yields good results. Its most common complication is wound infection. OBJECTIVE To determine the effectiveness of coccygectomy in patients with coccygodynia. METHODS A retrospective review of 70 patients (52 females and 18 males) with coccygodynia at King Khalid University Hospital in Riyadh was carried out, and the outcomes were studied. Twenty patients did not respond to conservative management; therefore, bimanual coccyx manipulation was done. Eleven were identified with instability and did not respond to coccygeal manipulation. Coccygectomy was performed on 8 patients while 3 declined. RESULTS All patients who underwent coccygectomy showed improvement of their symptoms. One case of superficial wound infection and delayed wound healing was encountered. CONCLUSION Coccygectomy provides effective pain relief to patients not responding to conservative therapies.
Collapse
|
26
|
Marwan Y, Dahrab B, Esmaeel A, Ibrahim SA, Al-Failakawi J. Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:591-598. [DOI: 10.1007/s00590-016-1896-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/23/2016] [Indexed: 11/25/2022]
|
27
|
Baba-Rasul I, Hama Ameen HM, Khazendar A, Hasan SO. A Rare Case of Isolated Lower Segment Transverse Sacral Fracture in a 12-Year-Old Girl and Its Management by Fixation with K-Wire. World Neurosurg 2016; 97:758.e1-758.e5. [PMID: 27746253 DOI: 10.1016/j.wneu.2016.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/02/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Isolated lower segment sacral fracture is very rare. To the best of our knowledge, there is only one case report of S4 stable fracture that was treated conservatively. CASE DESCRIPTION Here, we report a 12-year-old girl who sustained an isolated S5 fracture with anterior displacement of S5 and coccyx on S4. The patient initially was managed conservatively 1 month and 25 days. On the failure of this treatment procedure, the patient was treated surgically by partial coccygectomy with S4-S5 fixation after reduction by 2 K-wires. CONCLUSIONS Sacral fracture is difficult to diagnose, especially when the patient has multiple injuries. This is because the emergency doctor may not perform a neurologic examination of the perineum and may miss its diagnosis. Another reason for its misdiagnosis is that the routine anteroposterior plain X-ray may not detect it. Trauma patients with sacrococcygeal pain and tenderness should raise concerns about sacral fracture, and a lateral plain X-ray and/or computed tomography of the sacrococcygeal spine should be performed. Neurologic deficit is rare in lower sacral segment fracture; hence, a trial of conservative management (same as for coccygeal fracture) should be tried first. If the patient does not respond and there is displacement, surgical intervention can be used, because it has a very good response from the patient. In the presence of a neurological deficit, however, surgical intervention should be attempted as soon as possible.
Collapse
Affiliation(s)
- Ismaeel Baba-Rasul
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Orthopedics, Surgical Teaching Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Hemin M Hama Ameen
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Awder Khazendar
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Seerwan O Hasan
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital, Sulaymaniyah, Kurdistan, Iraq.
| |
Collapse
|
28
|
Hanley EN, Ode G, Jackson Iii BJ, Seymour R. Coccygectomy for patients with chronic coccydynia: a prospective, observational study of 98 patients. Bone Joint J 2016; 98-B:526-33. [PMID: 27037436 DOI: 10.1302/0301-620x.98b4.36641] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/02/2015] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this prospective study was to evaluate the outcomes of coccygectomy for patients with chronic coccydynia. PATIENTS AND METHODS Between 2007 and 2011, 98 patients underwent coccygectomy for chronic coccydynia. The patients were aged > 18 years, had coccygeal pain, local tenderness and a radiological abnormality, and had failed conservative management. Outcome measures were the Short Form 36 (SF-36), the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) for pain. Secondary analysis compared the pre-operative features and the outcomes of patients with successful and failed treatment, two years post-operatively. The threshold for success was based on a minimum clinically important difference (MCID) on the ODI of 20 points. All other patients, including those lost to follow-up, were classified as failures. RESULTS There was significant improvement in all ten components of the SF-36 (p < 0.05), the ODI (23 points) and VAS (39 points) (p < 0.0001). A total of 69 patients (70.4%) met the designated MCID threshold for a successful outcome. The failure group consisted of 25 patients (25.5%) who did not reach the MCID and four (4.1%) who were lost to follow-up. Six patients (6.1%) in the failure group had ODI scores that were no better or worse than that pre-operatively. The patients in whom treatment failed had significantly worse pre-operative scores for the ODI (p = 0.04), VAS (p = 0.02) and on five of ten SF-36 components (p < 0.04). They also had a higher incidence of psychiatric disorders, pre-operative opiate use and more than three comorbidities. TAKE HOME MESSAGE Coccygectomy for chronic coccydynia results in significant improvement in patient-reported outcomes at two years. Failure is associated with certain pre-operative characteristics such as psychiatric illness, poor quality of life features, higher levels of pain, and use of opiates.
Collapse
Affiliation(s)
- E N Hanley
- Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300 Charlotte, NC 28204, USA
| | - G Ode
- Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300 Charlotte, NC 28204, USA
| | - B J Jackson Iii
- University of South Carolina, 2 Medical Park, Columbia, SC 29203, USA
| | - R Seymour
- Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300 Charlotte, NC 28204, USA
| |
Collapse
|
29
|
Scott KM, Fisher LW, Bernstein IH, Bradley MH. The Treatment of Chronic Coccydynia and Postcoccygectomy Pain With Pelvic Floor Physical Therapy. PM R 2016; 9:367-376. [PMID: 27565640 DOI: 10.1016/j.pmrj.2016.08.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Revised: 07/26/2016] [Accepted: 08/17/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Coccydynia is a challenging disorder that often is refractory to treatments such as medications and injections. Physical therapy for coccydynia rarely has been studied. OBJECTIVE To evaluate the efficacy of pelvic floor physical therapy for reducing pain levels in patients with coccydynia. DESIGN Retrospective chart review. SETTING The pelvic floor rehabilitation clinic of a major university hospital. PATIENTS A total of 124 consecutive patients over age 18 with a chief complaint of coccydynia between 2009 and 2012. A subgroup of 17 of the 124 patients had previously undergone coccygectomy with continued pain postoperatively. METHODS OR INTERVENTIONS The primary treatment intervention was pelvic floor physical therapy aimed at pelvic floor muscle relaxation. Secondary treatment interventions included the prescription of baclofen for muscle relaxation (19% of patients), ganglion impar blocks (8%), or coccygeus trigger point injections (17%). MAIN OUTCOME MEASURES Primary outcome measures included final minimum, average, and maximum pain numeric rating scales. A secondary outcome measure was the patient's subjective percent global improvement assessment. Baseline demographics were used to determine which pretreatment characteristics were correlated with treatment outcomes. RESULTS Of the 124 patients, 93 participated in pelvic floor physical therapy and were included in statistical analysis. For the 79 patients who completed treatment (with a mean of 9 physical therapy sessions), the mean average pain ratings decreased from 5.08 to 1.91 (P < .001) and mean highest pain ratings decreased from 8.81 to 4.75 (P < .001). The mean percent global improvement was 71.9%. Mean average pain ratings in postcoccygectomy patients improved from 6.64 to 3.27 (P < .001). Greater initial pain scores and a history of previous injections were correlated with P < .001 pain scores on completion of physical therapy. Pain duration and history of trauma did not affect treatment outcomes. CONCLUSIONS Pelvic floor physical therapy is a safe and effective method of treating coccydynia. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Kelly M Scott
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9055(∗).
| | - Lauren W Fisher
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX; Department of Physical Medicine and Rehabilitation, Providence St. Peter Medical Center, Olympia, WA(†)
| | - Ira H Bernstein
- Department of Clinical Sciences, Division of Biostatistics, University of Texas Southwestern Medical Center, Dallas, TX(‡)
| | - Michelle H Bradley
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX(§)
| |
Collapse
|
30
|
Lee JY, Gil YC, Shin KJ, Kim JN, Joo SH, Koh KS, Song WC. An Anatomical and Morphometric Study of the Coccyx Using Three-Dimensional Reconstruction. Anat Rec (Hoboken) 2015; 299:307-12. [DOI: 10.1002/ar.23300] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 10/19/2015] [Accepted: 10/21/2015] [Indexed: 12/28/2022]
Affiliation(s)
- Ju-Young Lee
- Department of Anatomy; Research Institute of Medical Science, Konkuk University School of Medicine; Seoul Republic of Korea
| | - Young-Chun Gil
- Department of Anatomy; Research Institute of Medical Science, Konkuk University School of Medicine; Seoul Republic of Korea
| | - Kang-Jae Shin
- Department of Anatomy; Research Institute of Medical Science, Konkuk University School of Medicine; Seoul Republic of Korea
| | - Jeong-Nam Kim
- Department of Biomedical Laboratory; Masan University; Masan Republic of Korea
| | - Sung-Hong Joo
- Department of Obstetrics & Gynecology; National Medical Center; Seoul Republic of Korea
| | - Ki-Seok Koh
- Department of Anatomy; Research Institute of Medical Science, Konkuk University School of Medicine; Seoul Republic of Korea
| | - Wu-Chul Song
- Department of Anatomy; Research Institute of Medical Science, Konkuk University School of Medicine; Seoul Republic of Korea
| |
Collapse
|
31
|
Galhom A, al-Shatouri M, El-Fadl SA. Evaluation and management of chronic coccygodynia: Fluoroscopic guided injection, local injection, conservative therapy and surgery in non-oncological pain. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
32
|
Itz CJ, Willems PC, Zeilstra DJ, Huygen FJ. Dutch Multidisciplinary Guideline for Invasive Treatment of Pain Syndromes of the Lumbosacral Spine. Pain Pract 2015; 16:90-110. [DOI: 10.1111/papr.12318] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 04/07/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Coen J. Itz
- Department of Anesthesiology; Erasmus Medical Center; Rotterdam The Netherlands
- Health Insurance Company VGZ Eindhoven; Eindhoven The Netherlands
| | - Paul C. Willems
- Department of Orthopedic Surgery; Maastricht University Medical Centre; Maastricht The Netherlands
| | - Dick J. Zeilstra
- Neurosurgery; Nedspine Ede and Bergman Clinics Naarden; Ede and Naarden The Netherlands
| | - Frank J. Huygen
- Department of Anesthesiology; Centre of Pain Medicine; Erasmus Medical Center; Rotterdam the Netherlands
| |
Collapse
|
33
|
|
34
|
Doursounian L, Maigne JY, Jacquot F. Coccygectomy for coccygeal spicule: a study of 33 cases. 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 2015; 24:1102-8. [PMID: 25559295 DOI: 10.1007/s00586-014-3753-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 12/30/2014] [Accepted: 12/30/2014] [Indexed: 12/19/2022]
Abstract
PURPOSE To report the results of coccygectomy for coccygeal spicule. METHODS We report the results of a retrospective series of 33 patients who underwent coccygectomy for coccygeal spicule. There were 31 women and 2 men. The mean age was 42 ± 12 years (range 23-62). There was a pit in the skin overlying the spicule in 14 cases and the spicule was bulky in 8 cases. In three cases, weight loss had preceded the occurrence of the coccygodynia. The coccyx was rigid or had very reduced mobility (less than 5°) in 25 cases and normal mobility (between 5° and 20° of flexion) in 8 cases. All the patients had initially been managed conservatively with injections targeted on the spicule. As they did not obtain sufficient relief, they were offered surgery. Ten patients were followed up for more than 72 months, 10 patients for 48-66 months, and 13 for 30-42 months. The outcome analysis involved functional criteria only. RESULTS Twenty-six patients (79%) had a very satisfactory outcome and 7 (21%) an unsatisfactory outcome. When asked 'Would you have the surgery again?', only one patient answered in the negative. CONCLUSIONS Surgical treatment for coccygeal spicules that are causing coccygodynia and are resistant to conservative treatment gives satisfactory outcomes, similar to those obtained from surgery for instability of the coccyx.
Collapse
Affiliation(s)
- Levon Doursounian
- Department of Orthopaedic Surgery and Traumatology, Saint-Antoine Hospital, 184, rue du Faubourg-Saint-Antoine, 75571, Paris Cedex 12, France,
| | | | | |
Collapse
|
35
|
Abstract
STUDY DESIGN Cross-sectional, retrospective. OBJECTIVE To identify morphological and morphometric features of the coccyx among adult Arabs. SUMMARY OF BACKGROUND DATA Different sacrococcygeal morphologic features were found to be associated with coccydynia. METHODS Review of 202 computed tomographic scans of adult Arab subjects was done (mean age: 47.98 ± 16.46 yr). Sacrococcygeal morphological features including number of coccygeal segments, type of coccyx, joint fusion, joint subluxation, coccygeal spicule, coccygeal sacralization, ventral angulation of the terminal sacral segment (S5), and lateral deviation of coccygeal tip were recorded. Moreover, morphometric measurements including lengths and angles of the sacrococcygeal region were measured. Analysis of data was carried out using P value of less than 0.05 as the cutoff level of significance. RESULTS Three coccygeal segments were present in 138 (68.3%) of individuals. The majority of the subjects had coccyx type I (96; 47.5%), II (70; 34.7%), or III (31; 15.3%); type I being more common among males (P = 0.004). Bony spicule was present in 109 (54.0%) individuals. Joint fusion, joint subluxation, coccygeal sacralization, ventral angulation of S5, and lateral deviation of coccygeal tip were present in 38.6%, 31.7%, 34.2%, 38.1%, and 38.6% of the subjects, respectively. Joint subluxation and ventral angulation of S5 were more significantly present among females (P = 0.015, P = 0.014, respectively). The mean straight and curved lengths of the coccyx were 3.3 ± 0.7 cm and 3.7 ± 0.8 cm, respectively. The sacrococcygeal structures were longer in males than in females. The mean sacrococcygeal joint angle was 149.2°± 28.1°. Based on the morphometric measurements, the coccyx was more ventrally angulated among females. CONCLUSION The coccygeal morphology and morphometry of Arab adults share some similarities and differences with individuals of other ethnic backgrounds. Future studies should investigate the relation between these anatomic features with coccydynia among this population. LEVEL OF EVIDENCE 3.
Collapse
|
36
|
Haddad B, Prasad V, Khan W, Alam M, Tucker S. Favourable outcomes of coccygectomy for refractory coccygodynia. Ann R Coll Surg Engl 2014; 96:136-9. [PMID: 24780672 DOI: 10.1308/003588414x13814021676675] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Coccygodynia is a condition associated with severe discomfort in the region of the coccyx. While traditional procedures had poor outcomes and high complication rates, recent literature suggests better outcomes and lower complication rates with coccygectomy. METHODS Data were collected retrospectively from clinical notes. A questionnaire was used to evaluate the outcomes. The outcome measures included pain analogue score (PAS) in sitting and during daily activities as well as patients' overall pain relief. Overall improvement in pain and complications were documented. RESULTS Between 2000 and 2010, 14 patients underwent total coccygectomy for refractory coccygodynia. All patients were available for follow-up appointments and the follow-up duration ranged from 24 to 132 months (mean: 80 months). The aetiology was traumatic in eight patients and non-traumatic in six. The PAS improved from a median of 9 to 4 for sitting and from 7.5 to 2.5 for daily activities. One patient had mild discharge for more than two weeks. No patients required further surgery. Twelve patients (85.7%) had excellent or good pain relief. Only one patient was unsatisfied. A Wilcoxon signed-rank test revealed significant improvement in pain when sitting (p<0.05) and during activities of daily living (p<0.05) at the final follow-up visit. A Mann-Whitney U test did not show a significant difference in improvement in PAS between the traumatic and non-traumatic groups (p=0.282 and 0.755). CONCLUSIONS In our series, total coccygectomy offered satisfactory relief of pain in the majority of patients with a low wound complication rate.
Collapse
Affiliation(s)
- B Haddad
- Royal National Orthopaedic Hospital NHS Trust, UK
| | | | | | | | | |
Collapse
|
37
|
Marwan Y, Husain W, Alhajii W, Mogawer M. Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases. Spine J 2014; 14:e1-4. [PMID: 24094989 DOI: 10.1016/j.spinee.2013.07.438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 06/27/2013] [Accepted: 07/13/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Extracorporeal shock wave therapy (ECSWT) has been used widely for musculoskeletal conditions; however, no reports are available about its use for coccydynia. PURPOSE Study the effect of ECSWT in relieving pain of coccydynia. STUDY DESIGN Case report. METHODS Extracorporeal shock wave therapy was used for two male patients, Patients 1 and 2, who failed to respond completely to other conservative management of coccydynia. Numerical pain scale (NPS) and visual analogue scale (VAS) were used to assess the pain. Consent to publish the data was obtained from both the patients. RESULTS Before starting ECSWT, Patient 1 reported a pain intensity of 6/10 and 5.1/10 on NPS and VAS, respectively, whereas the intensity of pain in Patient 2 was 7/10 and 6.9/10 on NPS and VAS, respectively. Four weeks after ECSWT, Patient 1 reported complete relief of pain on NPS and VAS, whereas Patient 2 reported a pain intensity of 1/10 and 0.8/10 on NPS and VAS, respectively. The same intensity of pain was reported by both patients after 12 months of follow-up. CONCLUSIONS Extracorporeal shock wave therapy relieved pain of coccydynia in our patients.
Collapse
Affiliation(s)
- Yousef Marwan
- Department of Orthopaedic Surgery, Jaber Al-Ahmad Armed Forces Hospital, PO Box 24923, 13110 Safat, Kuwait.
| | - Wael Husain
- Department of Orthopaedic Surgery, Jaber Al-Ahmad Armed Forces Hospital, PO Box 24923, 13110 Safat, Kuwait
| | - Waleed Alhajii
- Department of Radiology, Jaber Al-Ahmad Armed Forces Hospital, Safat, Kuwait
| | - Magdy Mogawer
- Department of Radiology, Jaber Al-Ahmad Armed Forces Hospital, Safat, Kuwait
| |
Collapse
|
38
|
Kwon HD, Schrot RJ, Kerr EE, Kim KD. Coccygodynia and coccygectomy. KOREAN JOURNAL OF SPINE 2012; 9:326-33. [PMID: 25983841 PMCID: PMC4430558 DOI: 10.14245/kjs.2012.9.4.326] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 10/26/2012] [Accepted: 12/14/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A review of the literature on coccygectomy and our patients was performed to assess the effectiveness of coccygectomy for chronic refractory coccygodynia. METHODS An English language PubMed search was conducted with the terms "coccygodynia" and "coccygectomy" from January 1980 to January 2012. We retrospectively reviewed the medical records and performed telephone questionnaire on 61 patients who underwent coccygectomy at UCDMC between 1997 and 2009. RESULTS There were 28 case series from 1980 to 2012 for a total of 742 patients who underwent coccygectomy following failed conservative management. The mean age ranged from 26.4 to 52.8 years. The most common cause was direct trauma (58.5%) with a male:female ratio of 1:5.2. Most patients (84%) had a good to excellent outcome after coccygectomy. The most common complication is wound infection (10.0%). The overall complication rate was 13.3%. Similarly, 84.6% of patients from our own surgical case series reported good to excellent outcomes with 11.5% wound infection. CONCLUSION Coccygectomy is an effective treatment for chronic refractory coccygodynia. The surgery isrelatively simple to perform but precaution must be taken to avoid wound infection.
Collapse
Affiliation(s)
- Heum Dai Kwon
- Department of Neurological Surgery, Spine Center, Pohang Stroke and Spine Hospital, Pohang, Republic of Korea
| | - Rudolph J Schrot
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Edward E Kerr
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, California, USA
| | - Kee D Kim
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, California, USA
| |
Collapse
|
39
|
Woon JTK, Perumal V, Maigne JY, Stringer MD. CT morphology and morphometry of the normal adult coccyx. 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 2012. [PMID: 23192732 DOI: 10.1007/s00586-012-2595-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Lack of data on the in vivo morphology and morphometry of the normal adult coccyx hampers understanding of radiological abnormalities in idiopathic coccydynia. The aim of this study was to investigate normal adult sacrococcygeal morphometry. METHODS Retrospective analysis of 112 adult CT scans (mean age 63 ± 14.6 years, 50 males) evaluated the following: number of coccygeal segments; joint fusion; coccygeal spicules, subluxation, sacralization, and scoliosis; sacrococcygeal straight and curved lengths and curvature indices; sacrococcygeal and intercoccygeal angles; and lateral deviation of the coccyx tip. RESULTS Four coccygeal segments were present in 76 % of scans. Sacrococcygeal fusion was present in 57 % and intercoccygeal fusion was increasingly common more caudally; there was no significant association with age or gender. A bony spicule was present in 23 %. Subluxation was rare. Nine of 12 coccyges with a retroverted tip were female. Mean coccygeal curved length was 4.4 ± 0.8 cm in men and 4.0 ± 0.8 cm in women (P < 0.01). Mean angle between first and last coccygeal segments was 138° ± 25° in men and 147° ± 25° in women (P = 0.08). There was no significant correlation between coccygeal length or curvature and stature, age or BMI. CONCLUSIONS In this first detailed study of the CT morphology and morphometry of the adult coccyx, sacrococcygeal and intercoccygeal joint fusion was common. Female coccyges were shorter, straighter, and may be more prone to retroversion, factors that may be relevant to the markedly higher prevalence of idiopathic coccydynia in women.
Collapse
Affiliation(s)
- Jason T K Woon
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin, New Zealand
| | | | | | | |
Collapse
|
40
|
Cortiñas Sáenz M, Iglesias Cerrillo J, Vázquez Colomo C, Salmerón Vélez G, Quirante Pizarro A, Jerez Collado F. Infiltración del ganglio impar y caudal en el manejo de la coccigodinia traumática rebelde al tratamiento analgésico convencional. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recot.2011.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
41
|
Cortiñas Sáenz M, Iglesias Cerrillo J, Vázquez Colomo C, Salmerón Vélez G, Quirante Pizarro A, Jerez Collado F. Infiltration of impar and caudal ganglia in the management of traumatic coccydynia refractory to conventional analgesic treatment. Rev Esp Cir Ortop Traumatol (Engl Ed) 2011. [DOI: 10.1016/j.recote.2011.05.004] [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] Open
|
42
|
Woon JT, Stringer MD. Clinical anatomy of the coccyx: A systematic review. Clin Anat 2011; 25:158-67. [DOI: 10.1002/ca.21216] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2011] [Revised: 04/30/2011] [Accepted: 05/13/2011] [Indexed: 12/13/2022]
|
43
|
Kerr EE, Benson D, Schrot RJ. Coccygectomy for chronic refractory coccygodynia: clinical case series and literature review. J Neurosurg Spine 2011; 14:654-63. [PMID: 21332277 DOI: 10.3171/2010.12.spine10262] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECT Coccygodynia is disabling pain in the coccyx and is usually provoked by sitting or rising from sitting. The diagnosis can be missed by neurosurgeons likely to encounter the disorder, and surgical treatment for coccygodynia has historically been viewed with caution. The authors conducted a retrospective review of 62 successive coccygectomy surgeries for coccygodynia performed at their institution. METHODS Sixty-two consecutive cases of coccygectomy for coccygodynia in 61 unique patients were identified from the surgical database; they had been treated between 1997 and 2009. The authors succeeded in contacting 26 patients for follow-up (42.6%). A retrospective chart review was performed, and a telephone questionnaire was administered to these patients. Data collected included cause, pre- and postoperative visual analog scale, a graded outcome measure, and patient satisfaction. The median follow-up time was 37 months (range 2-133 months). RESULTS The clinical results among the 26 patients with follow-up were as follows: 13 excellent, 9 good, 2 fair, and 2 poor. The overall favorable (excellent and good) outcome after coccygectomy was 84.6%. There were 3 wound infections (11.5%). There were no rectal injuries. An overwhelming majority of patients were satisfied with the procedure. CONCLUSIONS The authors report the results of their clinical case series, which to date is the largest in North America. The results closely concur with previously published case series from Europe. Coccygectomy for chronic intractable coccygodynia is simple and effective, with a low complication rate. A comprehensive literature review and discussion of coccygectomy is provided.
Collapse
Affiliation(s)
- Edward E Kerr
- Department of Neurological Surgery, University of California Davis Medical Center, Sacramento, California 95817, USA
| | | | | |
Collapse
|
44
|
Abstract
Coccydynia is a painful disorder characterised by coccygeal pain which is typically exaggerated by pressure. It remains an unsolved mystery because of the perceived unpredictability of the origin of the pain, some psychological traits that may be associated with the disorder, the presence of diverse treatment options, and varied outcomes. A more detailed classification based on the aetiology and pathoanatomy of coccydynia helps to identify patients who may benefit from conservative and surgical management. This review focuses on the pathoanatomy, aetiology, clinical features, radiology, treatment and outcome of coccydynia.
Collapse
Affiliation(s)
- S. T. Nathan
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 210 E. Gray Street, Suite 1003, Louisville, Kentucky 40202, USA
| | - B. E. Fisher
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 210 E. Gray Street, Suite 1003, Louisville, Kentucky 40202, USA
| | - C. S. Roberts
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 210 E. Gray Street, Suite 1003, Louisville, Kentucky 40202, USA
| |
Collapse
|