1
|
Nagappa S, Alshameeri Z, Elmajee M, Hashmi Y, Bowry A, Jones M, Spilsbury J. Clinical Outcome of Coccygectomy Using a Paramedian Curvilinear Skin Incision in Adults and Children With Meta-Analysis of the Literature Focusing on Postoperative Wound Infection. Global Spine J 2023; 13:1878-1893. [PMID: 34875185 PMCID: PMC10556909 DOI: 10.1177/21925682211058155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN A single surgeon case series and meta-analysis of literature. OBJECTIVE To evaluate the clinical outcome and patient satisfaction following coccygectomy for coccygodynia in adults and children using a curvilinear paramedian skin incision and to conduct a meta-analysis of the literature to determine the associated infection rate with different surgical factors. METHODS 45 consecutive patients (40 adults and 5 children) underwent surgical coccygectomy for persistent coccygodynia symptoms using a paramedian curvilinear incision. Postoperative clinical outcome scores, patients' satisfaction and wound complications were assessed. A systematic literature search using specific MesH terms was then conducted covering the period from 1980 to 2020. Only those studies reporting infection rates post coccygectomy were included in a meta-analysis. RESULTS The average age of patients was 39 years with a mean duration of symptoms prior to surgery of 7.4 years. The mean Oswestry Disability Index improved from 29 to 7.7 (P < .001). The mean pain Visual analogue scale improved from 8 to 2 (P < .001) and the median patient satisfaction score was 8 (out of 10) suggesting good to excellent outcome. The clinical improvement was the same in children and adults. There was a total of 5 (11%) wound infections, 2 of which needed surgical debridement. Meta-analysis of the included studies showed that the use of prophylactic antibiotics for 24 hours, nonabsorbable skin sutures and glue were associated with low infection rate. CONCLUSIONS Coccygectomy using curvilinear paramedian skin incision for chronic coccygodynia is an effective procedure with similar or lower complication rates as reported in the literature.
Collapse
Affiliation(s)
- Satish Nagappa
- Department of Spine Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
- Sandwell and West Birmingham Hospitals NHS Trust, West Bromwich, UK
| | - Zeiad Alshameeri
- Department of Spine Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
- University Hospitals of North Midlands, Royal Stoke University Hospita, Stoke-on-Trent, UK
| | - Mohammad Elmajee
- Department of Spine Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Yousuf Hashmi
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ajay Bowry
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Morgan Jones
- Department of Spine Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
| | - Jonathan Spilsbury
- Department of Spine Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
| |
Collapse
|
2
|
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
|
3
|
Sagoo NS, Haider AS, Palmisciano P, Vannabouathong C, Gonzalez R, Chen AL, Lokesh N, Sharma N, Larsen K, Singh R, Mulpuri N, Rezzadeh K, Caldwell C, Tappen LA, Gill K, Vira S. Coccygectomy for refractory coccygodynia: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 31:176-189. [PMID: 34694498 DOI: 10.1007/s00586-021-07041-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 09/11/2021] [Accepted: 10/18/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE We sought to systematically assess and summarize the available literature on outcomes following coccygectomy for refractory coccygodynia. METHODS PubMed, Scopus, and Cochrane Library databases were systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data concerning patient demographics, validated patient reported outcome measures (PROMs) for pain relief, disability outcomes, complications, and reoperation rates were extracted and analyzed. RESULTS A total of 21 studies (18 retrospective and 3 prospective) were included in the quantitative analysis. A total of 826 patients (females = 75%) received coccygectomy (720 total and 106 partial) for refractory coccygodynia. Trauma was reported as the most common etiology of coccygodynia (56%; n = 375), followed by idiopathic causes (33%; n = 221). The pooled mean difference (MD) in pain scores from baseline on a 0-10 scale was 5.03 (95% confidence interval [CI]: 4.35 to 6.86) at a 6-12 month follow-up (FU); 5.02 (95% CI: 3.47 to 6.57) at > 12-36 months FU; and 5.41 (95% CI: 4.33 to 6.48) at > 36 months FU. The MCID threshold for pain relief was surpassed at each follow-up. Oswestry Disability Index scores significantly improved postoperatively, with a pooled MD from baseline of - 23.49 (95% CI: - 31.51 to - 15.46), surpassing the MCID threshold. The pooled incidence of complications following coccygectomy was 8% (95% CI: 5% to 12%), the most frequent of which were surgical site infections and wound dehiscence. The pooled incidence of reoperations was 3% (95% CI: 1% to 5%). CONCLUSION Coccygectomy represents a viable treatment option in patients with refractory coccygodynia.
Collapse
Affiliation(s)
- Navraj S Sagoo
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Ali S Haider
- Deparment of Neurosurgery, MD Anderson Cancer Center, Houston, TX, USA
| | - Paolo Palmisciano
- Department of Neurosurgery, Trauma and Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Christopher Vannabouathong
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Roberto Gonzalez
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Andrew L Chen
- Department of Orthopaedic Surgery, Texas Tech University School of Medicine, Lubbock, TX, USA
| | - Nidhish Lokesh
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Neha Sharma
- Roseman University of Health Sciences, South Jordan, UT, USA
| | - Kylan Larsen
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Ravinderjit Singh
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Neha Mulpuri
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Kevin Rezzadeh
- 6Department of Orthopaedic Surgery, Cedars-Sinai Orthopaedics, Los Angeles, CA, USA
| | - Christie Caldwell
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Lori A Tappen
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Kevin Gill
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA
| | - Shaleen Vira
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, MC 8855, USA.
| |
Collapse
|
4
|
White WD, Avery M, Jonely H, Mansfield JT, Sayal PK, Desai MJ. The interdisciplinary management of coccydynia: A narrative review. PM R 2021; 14:1143-1154. [PMID: 34333873 DOI: 10.1002/pmrj.12683] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 07/05/2021] [Accepted: 07/27/2021] [Indexed: 11/07/2022]
Abstract
Pain that develops in the coccyx or surrounding tissues is known as coccydynia, which occurs as a result of many etiologies both traumatic and nontraumatic. Although coccydynia most commonly affects middle-aged women, it may be found in both sexes and in all age groups. The aim of this article is to provide an overview of the presentation, diagnostic imaging, and pathophysiology of coccydynia, and to comprehensively review the current treatment options. A review of publications from 1990 to 2020 using search words related to the treatment of coccydynia in PubMed and Google Scholar was completed. Level II evidence was found supporting stretching, manipulation, and extracorporeal shock wave therapy. There are no data from high-quality studies to support injection-based therapy including corticosteroids, prolotherapy, nerve blocks, and radiofrequency ablation, although there are small retrospective and prospective observational studies suggesting benefit. Level III evidence was found supporting coccygectomy for chronic/refractory coccydynia. There are no data from randomized controlled trials to support the use of neuromodulation (sacral burst and dorsal root ganglion stimulation), although there are case reports suggesting benefit. High-level, comparative studies are lacking to guide the treatment of coccydynia and should be a focus for future research studies.
Collapse
Affiliation(s)
- William D White
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Melinda Avery
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Holly Jonely
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - John T Mansfield
- Department of Rehabilitation Medicine, MedStar Georgetown University Hospital, Washington, District of Columbia, USA.,MedStar National Rehabilitation Hospital, Physical Medicine & Rehabilitation, Washington, District of Columbia, USA.,International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Puneet K Sayal
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA
| | - Mehul J Desai
- International Spine, Pain & Performance Center, Washington, District of Columbia, USA.,The George Washington University, School of Medicine and Health Sciences, Washington, District of Columbia, USA
| |
Collapse
|
5
|
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
|
6
|
Seker A, Sarikaya IA, Korkmaz O, Yalcin S, Malkoc M, Bulbul AM. Management of persistent coccydynia with transrectal manipulation: results of a combined procedure. 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 2018; 27:1166-1171. [PMID: 29234884 DOI: 10.1007/s00586-017-5399-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 11/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE We compared the results of manual therapy combined with steroid injection with single steroid injection in the treatment of persistent coccydynia. PATIENTS AND METHODS Combined therapy was performed in 21 patients (Group 1) and steroid injection in 23 patients (Group 2). We compared two groups and investigated the combined therapy group in details. Patients were classified according to the underlying cause, BMI, anatomic type of coccyx and duration of symptoms (< 6 or ≥ 6 months). RESULTS Mean age was 30.5 years at the time of procedures. Mean followup time was 27.8 months. VAS scores were decreased in both groups but combined therapy group had much more better results. Complete pain relief was achieved in 61.9% of patients in Group 1 whereas it was only 17.4% in Group 2. In 23.8% of Group 1, the VAS score was significantly decreased but the feeling of uncomfortability persisted. This was 73.9% in Group 2. We had no relapse in Group 1 but in Group 2 the relapse rate was 56.5%. Underlying cause, body mass index, anatomic type of coccyx and duration of symptoms had no effect on results. CONCLUSION Manual therapy combined with steroid injection would be an alternative method in case of persistent coccydynia. It is a safe and easy option before surgical treatment.
Collapse
Affiliation(s)
- Ali Seker
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
| | | | - Ozgur Korkmaz
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
| | - Sercan Yalcin
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey.
| | - Melih Malkoc
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
| | - Ahmet Murat Bulbul
- Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey
| |
Collapse
|
7
|
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
|
8
|
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
|
9
|
Kleimeyer JP, Wood KB, Lønne G, Herzog T, Ju K, Beyer L, Park C. Surgery for Refractory Coccygodynia: Operative Versus Nonoperative Treatment. Spine (Phila Pa 1976) 2017; 42:1214-1219. [PMID: 28800569 DOI: 10.1097/brs.0000000000002053] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE To evaluate the long-term outcomes for patients with refractory coccygodynia treated with coccygectomy compared to a nonsurgical regimen of sitting aids, physical therapy, medications, and injections. SUMMARY OF BACKGROUND DATA The surgical treatment of coccygodynia remains controversial. To date, there has only been one small comparative study of surgical versus nonsurgical treatment. METHODS From 2004 to 2014, 109 patients presenting with coccygodynia were treated with either total coccygectomy or a nonsurgical course of sitting aids, physical therapy, anti-inflammatory medications, and injections. All had at least 2 years of symptoms before surgery. The patient principally made the treatment decision, counseled by the treating physician. Before surgery, all subjects underwent at least 2 years of conservative treatment and three-dimensional imaging (computed tomography and/or magnetic resonance imaging). Subjects completed visual analog pain scales, EuroQol five-dimension, components of the PROMIS measure, and a novel Coccygodynia Disability Index evaluation. Work status, complications, and satisfaction were recorded. RESULTS A total of 61 patients received nonsurgical care; eight declined participation and five could not be located. Forty-eight patients underwent total coccygectomy; three declined participation and five could not be located. At an average 4.8 years of follow-up (range: 2-9), the nonsurgical visual analog pain scales was 5 and the surgical 2 (P = 0.001); 79% of surgically treated patients were improved at 2 years versus 43% for the nonsurgical group. EuroQol five-dimension (P = 0.002), Coccygodynia Disability Index (0.01), and PROMIS Pain interference scores (0.02) were also significantly improved in the surgical group. Eleven surgical patients (26%) had complications, all wound related with successful resolution; seven treated with dressing changes and four with surgical debridement. CONCLUSION Total coccygectomy is a safe and effective surgical treatment of coccygodynia refractory to nonoperative care. Patient-reported outcome measures were improved after surgery compared with nonsurgical management. Postoperative wound care remains a concern. LEVEL OF EVIDENCE 4.
Collapse
Affiliation(s)
- John P Kleimeyer
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Kirkham B Wood
- Department of Orthopedic Surgery, Stanford University School of Medicine, Redwood City, CA
| | - Greger Lønne
- Department of Orthopaedic Surgery, Innlandet Hospital Trust, Lillehammer, Norway
| | - Tyler Herzog
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kevin Ju
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Lisa Beyer
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Christine Park
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| |
Collapse
|
10
|
Ogur HU, Seyfettinoğlu F, Tuhanioğlu Ü, Cicek H, Zohre S. An evaluation of two different methods of coccygectomy in patients with traumatic coccydynia. J Pain Res 2017; 10:881-886. [PMID: 28442929 PMCID: PMC5396938 DOI: 10.2147/jpr.s129198] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Purpose The aim of this study was to evaluate the results of partial and total coccyx excisions in patients with traumatic coccydynia resistant to conservative treatment. Patients and methods The study included 22 patients (from a total of 27) who underwent partial or total coccygectomy because of persistent coccydynia between December 2007 and January 2014. There were 15 females and 7 males with a mean age of 33.6 years (range 23–46 years). Partial coccygectomy was performed in 14 patients and total coccygectomy in 8. They were evaluated according to their pre- and postoperative visual analog scale (VAS) scores. The mean follow-up period was 28 months (range 16–48 months). Results The mean VAS scores in the total excision group were 8.88±0.64 preoperatively and 2.5±2.67 at the final postoperative follow-up examination. In the partial excision group, these values were 8.79±0.89 preoperatively and 2.5±2.85 postoperatively. No statistically significant difference was determined between the two groups with respect to the mean scores (p>0.05). No rectum injury was seen in any patient. When the VAS scores of the patients were evaluated as a whole, excellent and good results were obtained in 78%. Patient satisfaction with the operation was 90%. Conclusion Coccyx excision is a successful treatment method in patients with long-term coccydynia who are resistant to conservative treatment. Two different surgical methods can be applied in the treatment and both of them have low complication rates and high patient satisfaction.
Collapse
Affiliation(s)
- Hasan Ulas Ogur
- Department of Trauma and Orthopedics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Firat Seyfettinoğlu
- Department of Trauma and Orthopedics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ümit Tuhanioğlu
- Department of Trauma and Orthopedics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Hakan Cicek
- Department of Trauma and Orthopedics, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Sefa Zohre
- Department of Trauma and Orthopedics, Adana Numune Training and Research Hospital, Adana, Turkey
| |
Collapse
|
11
|
Haghighat S, Mashayekhi Asl M. Effects of Extracorporeal Shock Wave Therapy on Pain in Patients With Chronic Refractory Coccydynia: A Quasi-Experimental Study. Anesth Pain Med 2016; 6:e37428. [PMID: 27843777 PMCID: PMC5098426 DOI: 10.5812/aapm.37428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 04/10/2016] [Accepted: 05/23/2016] [Indexed: 12/12/2022] Open
Abstract
Background Several nonsurgical and surgical treatment modalities are available for patients with chronic coccydynia, with controversial results. Extracorporeal shock wave therapy (ECSWT) is effective in the treatment of many musculoskeletal disorders; however, it has not been tested for chronic coccydynia. Objectives We performed the current study to determine the effects of ECSWT on pain in patients with chronic coccydynia. Patients and Methods This quasi-interventional clinical study included 10 patients with chronic coccydynia without acute fracture. All the patients received ECSWT with a radial probe delivering 3,000 shock waves of 2 bar per session at 21 Hz frequency directed to the coccyx. Each patient received four sessions of ECSWT at one-week intervals. The pain severity was recorded according to the visual analog scale (VAS) at one, two, three, and four weeks after initiation of therapy. The VAS score was also evaluated at one and six months after ending the therapy. Results Most of the participants were women (90.0%), and the participants’ mean age was 39.1 ± 9.1 (ranging from 28 to 52) years. The VAS score did not decrease significantly seven months after therapy when compared to baseline (3.3 ± 3.6 vs. 7.3 ± 2.1; P = 0.011). However, the VAS score at two months (2.6 ± 2.9 vs. 7.3 ± 2.1; P = 0.007) and at four weeks (3.2 ± 2.8 vs. 7.3 ± 2.1; P = 0.007) significantly decreased when compared to baseline. The decrease in VAS scores was not persistent after cessation of the therapy. Conclusions ECSWT is an effective modality in relieving the pain intensity in patients with refractory chronic coccydynia for the early period after intervention.
Collapse
Affiliation(s)
- Shila Haghighat
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Mashayekhi Asl
- Department of Physical Medicine and Rehabilitation, Isfahan University of Medical Sciences, Isfahan, Iran
- Corresponding author: Mahboobeh Mashayekhi Asl, Department of Physical Medicine and Rehabilitation, Al-Zahra Hospital, Sofeh Avenue, P. O. Box: 8174675731, Isfahan, Iran. Tel: +98-3116234508, E-mail:
| |
Collapse
|