1
|
Rahimibarghani S, Morgan R, Diaz JJ. Neuromodulation Techniques in Chronic Refractory Coccydynia: A Narrative Review. Pain Ther 2024; 13:53-67. [PMID: 38175492 PMCID: PMC10796902 DOI: 10.1007/s40122-023-00572-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
Refractory coccydynia is a condition characterized by severe coccygeal pain and poses a challenging management dilemma for clinicians. Advancements in neuromodulation (NM) technology have provided benefits to people experiencing chronic pain that is resistant to standard treatments. This review aims to summarize the spectrum of current NM techniques employed in the treatment of refractory coccydynia along with their effectiveness. A review of studies in the scientific literature from 2012 to 2023 was conducted, revealing a limited number of case reports. Although the available evidence at this time suggests significant pain relief with the utilization of NM techniques, the limited scope and nature of the studies reviewed emphasize the need for large-scale, rigorous, high-level research in this domain in order to establish a comprehensive understanding of the role of NM and its effectiveness in the management of intractable coccydynia.
Collapse
Affiliation(s)
- Sarvenaz Rahimibarghani
- Physical Medicine and Rehabilitation Department, Tehran University of Medical Sciences, Tehran, Iran.
| | - Richard Morgan
- Miami Neuroscience Institute, Baptist Health South Florida, Miami, FL, USA
| | - Jose Juan Diaz
- Physical Medicine and Rehabilitation Department, Larkin Community Hospital, South Miami Campus, South Miami, FL, USA
| |
Collapse
|
2
|
Kara D, Pulatkan A, Ucan V, Orujov S, Elmadag M. Traumatic coccydynia patients benefit from coccygectomy more than patients undergoing coccygectomy for non-traumatic causes. J Orthop Surg Res 2023; 18:802. [PMID: 37891674 PMCID: PMC10605957 DOI: 10.1186/s13018-023-04098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 08/14/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE Conservative treatment is the first step in the management of coccydynia. However, surgical treatment is required in cases where conservative treatment fails. The aim of this study was to compare the effect of traumatic and atraumatic etiologies on functional outcomes in patients who underwent coccygectomy for chronic coccydynia. METHODS Ninety-seven patients who underwent partial coccygectomy between October 2010 and December 2018 for the diagnosis of chronic coccygodynia were evaluated retrospectively. The patients were divided into two groups according to etiologies as atraumatic (group AT) and traumatic (group T). Concomitant disorders of the patients were recorded as psychiatric and musculoskeletal diseases. Visual Analog Scale (VAS) for low back pain, the Oswestry Disability Index (ODI) scale, Short Form-36 Physical Component Summary and Short Form-36 Mental Component Summary were used to evaluate the clinical outcomes pre- and postoperative at the last follow-up. RESULTS The mean follow-up time was 67.3 ± 13.9 (range; 44-115) months. Group AT and group T included 48 (mean age 37.1 ± 11.3 and 36 (75%) female) and 49 patients (mean age 36 ± 11 and 35 (71.4%) female), respectively. The groups were statistically similar in terms of age (p = 0.614), gender (p = 0.691), body mass index (p = 0.885), tobacco usage (p = 0.603) and duration of pain (p = 0.073). However, the rate of musculoskeletal and total concomitant disorders was higher in the Group AT than in Group T (p < 0.05). The average preoperative SF-36 MCS and SF-36 PCS scores improved at the last follow-up from 43.3 ± 6.2 and 35.6 ± 4.9 to 72 ± 14.1 and 58.3 ± 10.9, respectively. The preoperative VAS and ODI decreased from 8 ± 1.4 and 39.8 ± 8.5 to 2.6 ± 1.8 and 13.4 ± 8.9 at the last follow-up, respectively. CONCLUSION Successful results were obtained with surgical treatment in chronic coccygodynia. In addition, functional outcomes in patients with traumatic etiology are better than in atraumatic ones. Levels of evidence Level III; Retrospective Comparative Study.
Collapse
Affiliation(s)
- Deniz Kara
- Orthopaedic Department, Washington University School of Medicine, Saint Louis, MO, USA.
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey.
| | - Anil Pulatkan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Vahdet Ucan
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Said Orujov
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| | - Mehmet Elmadag
- Department of Orthopedics and Traumatology, Bezmialem Vakif University School of Medicine, Fatih, Istanbul, Turkey
| |
Collapse
|
3
|
Şah V, Elasan S, Kaplan Ş. Comparative effects of radial and focused extracorporeal shock wave therapies in coccydynia. Turk J Phys Med Rehabil 2023; 69:97-104. [PMID: 37201007 PMCID: PMC10186009 DOI: 10.5606/tftrd.2023.10371] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 10/18/2022] [Indexed: 05/20/2023] Open
Abstract
Objectives This study was conducted to compare the effects of radial and focused extracorporeal shock wave therapy (ESWT) in patients with coccydynia. Patients and methods In this prospective randomized double-blind study conducted between March 2021 and October 2021, 60 patients with coccydynia (50 males, 10 females; mean age: 35.9±12.0 years, range 18 to 65 years) were randomized into three groups (n=20) according to different wave types of ESWT: focused, radial, and sham. The Visual Analog Scale (VAS) was used for pain assessment, and the Oswestry Disability Index (ODI) was used for functional assessment in all patients before the treatment (baseline), after the completion of four sessions of treatment (fourth week), one month after the end of the treatment (eighth week), and three months after the end of the treatment (16th week). Results The mean body mass index of the participants was 26.2±3.0. Compared to baseline, the VAS scores at four weeks were reduced only in the radial ESWT group (p<0.05). Compared to baseline, the VAS and ODI scores at eight and 16 weeks were significantly reduced in both the focused and radial ESWT groups (p<0.05 for all). The radial ESWT group was significantly superior to the focused ESWT group in the comparisons between the groups at four weeks in the VAS values and at 16 weeks in the ODI scores (p<0.05 for all). Conclusion Radial and focused ESWT are both effective in treating coccydynia compared to sham ESWT. However, radial ESWT may be more effective in the treatment of coccydynia.
Collapse
Affiliation(s)
- Volkan Şah
- Department of Sports Medicine, Yüzüncü Yıl University School of Medicine, Van, Türkiye
| | - Sadi Elasan
- Department of Biostatistics, Yüzüncü Yıl University School of Medicine, Van, Türkiye
| | - Şeyhmus Kaplan
- Department of Sports Medicine, Yüzüncü Yıl University School of Medicine, Van, Türkiye
| |
Collapse
|
4
|
Mosaad EH, Mohamed AY, Fawzy AA, Mohamed MH. The effect of adding kinesiotaping versus pelvic floor exercise to conventional therapy in the management of post-colonoscopy coccydynia: a single-blind randomized controlled trial. Afr Health Sci 2023; 23:575-583. [PMID: 37545928 PMCID: PMC10398457 DOI: 10.4314/ahs.v23i1.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Coccydynia is a challenging disorder that is frequently managed conservatively. Objective This study aimed to evaluate the efficacy of adding kinesiotaping versus pelvic floor exercise to conventional therapy in the management of post-colonoscopy coccydynia. Methods Forty-two participants, aged 25-45 years, were randomly assigned to: the conventional therapy group (CT) receiving Piriformis and Iliopsoas muscle stretching exercise, clamshell exercise, and seat cushioning; the CT plus kinesiotaping group (CT-KT) receiving additional kinesiotaping; or the CT plus pelvic floor exercise (PFE) group (CT-PFE) executing additional PFE. All groups completed 4 weeks of training, 3 days a week. Pain intensity, assessed by the Pain Numeric Rating Scale (PNRS), and functional disability, evaluated by the Oswestry Disability Index (ODI), were estimated at baseline and after 4 weeks. Results There were significant inter-group variations in PNRS and ODI, where (P = 0.0001) and (P = 0.03), respectively. Differences between experimental groups were noteworthy in terms of NPRS, where the major change was in favor of group CT-KT (P = 0.001). However, there was no significant difference between them regarding their impact on ODI. Conclusion CT-KT is more effective than CT-PFE in reducing pain associated with coccydynia post-colonoscopy, but there is no difference in their effects on functional disability. CT-KT is therefore recommended as an alternative treatment option for post-colonoscopy coccydynia.
Collapse
Affiliation(s)
- Eladl Hadaya Mosaad
- Cairo University Faculty of Physical Therapy, Department of physical therapy for Surgery
- Jouf University College of Applied Medical Science
| | - Aneis Yasser Mohamed
- Cairo University Faculty of Physical Therapy, Department of Physical Therapy for Basic Sciences
| | - Attalla Asmaa Fawzy
- Cairo University Faculty of Physical Therapy, Department of physical therapy for Surgery
| | - Mohamady Heba Mohamed
- Cairo University Faculty of Physical Therapy, Department of physical therapy for Surgery
| |
Collapse
|
5
|
Malik SH, Ahmad K, Ali L. Ganglion Impar Block For Chronic Coccydynia. J Ayub Med Coll Abbottabad 2023; 35:123-6. [PMID: 36849391 DOI: 10.55519/JAMC-01-11092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Coccydynia is also known as coccygodynia or coccygeal neuralgia. Coccyx is a triangular bone located within the vertebral column. The cause of coccydynia is unknown in the literature; however, it is found to be common among obese individuals, particularly females. The probability of women having coccydynia is five times higher than among men, which may result from larger pressure during pregnancy and child delivery. It is treated well with ganglion impar block. The aim of our study was to assess pain relief after Ganglion Impair Block with subsequent improvement in quality of life. METHODS A single-arm study was done in the department of Pain Medicine, Fauji Foundation Hospital, Rawalpindi from July 2021 to June 2022. A total of 50 patients with ≥3 months' coccygeal pain of either gender aged between 20-60 years unresponsive to analgesics & anti-inflammatory medications with no laboratory abnormalities were included. Fluoroscopic guided trans-sacro‑coccygeal ganglion impair block was done with alcohol neurolysis. The patients were observed for 1 hour in the recovery room to record post-intervention complications that may occur like hypotension, bradycardia, signs, and symptoms of cardiotoxicity or neurotoxicity etc. and evaluated for pain scores on the basis of the numeric rating scale (NRS). Data collected was analyzed using the statistical package for social scientists (SPSS) version 21. The quantitative data, i.e., age and NRS score were analyzed using mean and standard deviation and compared between pre and post-intervention periods. RESULTS The data from 50 patients who completed the follow-up period were used for analysis. The average age of the patients was 42.9±8.39 years, with a range of 38-60 years. Based on the data obtained, 30% of the patients experienced trauma (that is falling on the coccyx region). The mean score from NRS before intervention was 7.80±0.16 which decreased to 0.96±0.35, respectively, and this difference was statistically significant (p-value, <0.001). CONCLUSIONS Ganglion Impar neurolysis is highly effective in the treatment of chronic coccydynia.
Collapse
|
6
|
Allahverdi E, Allahverdi TD. A retrospective study on the pathologies in patients with coccydynia-lumbosacralgia and their treatment. Asian J Surg 2023; 46:688-691. [PMID: 35843825 DOI: 10.1016/j.asjsur.2022.06.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/20/2022] [Accepted: 06/16/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The aim of this study was to arrange the treatment according to the etiology following the differential diagnosis in patients who had presented to the Orthopedics and Traumatology and General Surgery outpatient departments, and to emphasize the post-treatment success. METHOD The charts of 156 patients who had presented to the Orthopedics and Traumatology, General Surgery Departments of the Kafkas University Faculty of Medicine between July 2012 and June 2021 were retrospectively reviewed after permission was obtained from the ethics committee in this study. The demographic findings and Visual Analogue Scale (VAS) results for those with a symptom of pain as detected during the physical examination were recorded from the patient charts. RESULTS A total of 156 patients who had presented with traumatic and non-traumatic conditions to the Orthopedics Clinic complaining of pain, burning, sensitivity, discharge and hyperemia at the coccyx region were included in the study. The reason for the lumbosacralgia was found to be traumatic as in heavy lifting or working physically difficult jobs in 62 of the 95 patients (65.26%) who presented with lumbosacralgia and pain referred to the coccyx. The mean VAS was 7.37 before treatment and 2.32 following conservative treatment. There was a history of falling on the coccyx region in 8 of the 14 patients with traumatic isolated coccydynia. The pre-treatment mean VAS was 8.64 in the patients with a diagnosis of coccydynia while the post-treatment mean VAS was 0 in 8 patients with full recovery, 4.33 in 3 patients with partial recovery, and 9.66 in 3 patients with no recovery. The pre-treatment mean VAS was 7.58 in the 29 patients with thrombosed hemorrhoids, decreasing to 0 after treatment. The pre-treatment mean VAS was 4.16 in the 18 patients with a pilonidal sinus, again decreasing to 0 after treatment. CONCLUSION Possible underlying etiological factors should be taken into account when making a diagnosis in patients with coccydynia and the treatment should be determined in a multidisciplinary manner.
Collapse
Affiliation(s)
- Ertugrul Allahverdi
- General Surgery Faculty of Medicine University of Kafkas, 36300 Kars, Turkey.
| | | |
Collapse
|
7
|
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
|
8
|
Charrière S, Maigne JY, Couzi E, Lefèvre-Colau MM, Rannou F, Nguyen C. Conservative treatment for chronic coccydynia: a 36-month prospective observational study of 115 patients. Eur Spine J 2021; 30:3009-3018. [PMID: 34216237 DOI: 10.1007/s00586-021-06911-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 05/01/2021] [Accepted: 06/24/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe long-term outcomes of conservative treatment for chronic coccydynia. METHODS We conducted a 36-month prospective observational study. Adults with chronic coccydynia (> 2 months) were included. The first-line treatment was coccygeal corticosteroid injection. The second-line treatment was either manual therapy or coccygectomy. The primary endpoint was the mean variation from baseline of coccydynia intensity at 6 and 36 months, using a numeric rating scale (0, no pain; 10, maximal pain). Evolution was considered unfavorable when coccydynia intensity was > 3 of 10 points at 36 months or coccygectomy had been performed. We carried out bivariate and multivariate analyses to identify variables associated with an unfavorable evolution. RESULTS We included 115 participants. Mean (SD) age was 43.5 (12.3) years, duration of coccydynia 18.4 (21.6) months and coccydynia intensity 6.5 (2.0) of 10 points. Mean variations for coccydynia intensity were - 1.5 (3.0) at 6 months and - 2.8 (3.2) at 36 months. At 36 months, 59/115 (51%) participants had an unfavorable evolution. In bivariate analysis, posterior coccyx dislocations were numerically more frequent in participants with an unfavorable evolution compared to others (29/59 (48%) versus 17/56 (30%), p = 0.057). In multivariate analysis, longer duration of coccydynia was associated with an unfavorable evolution (OR = 1.04, 95% CI from 1.01 to 1.07, p = 0.023). CONCLUSION In adults with chronic coccydynia receiving conservative treatment, symptoms decrease overtime, but significantly persist at 36 months in more than half of them. For patients with posterior coccyx dislocation, coccygectomy may be considered rapidly.
Collapse
Affiliation(s)
- Solène Charrière
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Jean-Yves Maigne
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Emmanuel Couzi
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France
| | - Marie-Martine Lefèvre-Colau
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France.,Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), INSERM UMR-S 1124, Campus Saint-Germain-des-Prés, 75006, Paris, France.,Institut Fédératif de Recherche Sur Le Handicap, 75013, Paris, France
| | - François Rannou
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France.,Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France.,Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, INSERM UMR-S 1153, 75004, Paris, France
| | - Christelle Nguyen
- Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. .,Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France. .,Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, INSERM UMR-S 1153, 75004, Paris, France.
| |
Collapse
|
9
|
Jensen MM, Milosevic S, Andersen GØ, Carreon L, Simony A, Rasmussen MM, Andersen MØ. Factors associated with patient-reported outcomes following coccygectomy for chronic coccydynia. Bone Jt Open 2021; 2:540-544. [PMID: 34278838 PMCID: PMC8325972 DOI: 10.1302/2633-1462.27.bjo-2021-0018.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The aim of this study was to identify factors associated with poor outcome following coccygectomy on patients with chronic coccydynia and instability of the coccyx. Methods From the Danish National Spine Registry, DaneSpine, 134 consecutive patients were identified from a single centre who had coccygectomy from 2011 to 2019. Patient demographic data and patient-reported outcomes, including pain measured on a visual analogue scale (VAS), Oswestry Disability Index (ODI), EuroQol five-dimension five-level questionnaire, and 36-Item Short-Form Health Survey questionnaire (SF-36) were obtained at baseline and at one-year follow-up. Patient satisfaction was obtained at follow-up. Regression analysis, including age, sex, smoking status, BMI, duration of symptoms, work status, welfare payment, preoperative VAS, ODI, and SF-36 was performed to identify factors associated with dissatisfaction with results at one-year follow-up. Results A minimum of one year follow-up was available in 112 patients (84%). Mean age was 41.9 years (15 to 78) and 97 of the patients were female (87%). Regression showed no statistically significant association between the investigated prognostic factors and a poor outcome following coccygectomy. The satisfied group showed a statistically significant improvement in patient-reported outcomes at one-year follow-up from baseline, whereas the dissatisfied group did not show a significant improvement. Conclusion We did not identify factors associated with poor outcome following coccygectomy. This suggests that neither of the included parameters should be considered contraindications for coccygectomy in patients with chronic coccydynia and instability of the coccyx. Cite this article: Bone Jt Open 2021;2(7):540–544.
Collapse
Affiliation(s)
- Mads Moss Jensen
- Cense-Spine, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Center for Spine Surgery & Research, Middelfart Hospital, Middelfart, Denmark
| | - Stefan Milosevic
- Cense-Spine, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Center for Spine Surgery & Research, Middelfart Hospital, Middelfart, Denmark
| | - Gustav Østerheden Andersen
- Cense-Spine, Department of Neurosurgery, Aarhus University Hospital, Aarhus, Denmark.,Center for Spine Surgery & Research, Middelfart Hospital, Middelfart, Denmark
| | - Leah Carreon
- Center for Spine Surgery & Research, Middelfart Hospital, Middelfart, Denmark
| | - Ane Simony
- Center for Spine Surgery & Research, Middelfart Hospital, Middelfart, Denmark
| | | | | |
Collapse
|
10
|
Garg B, Ahuja K. Coccydynia-A comprehensive review on etiology, radiological features and management options. J Clin Orthop Trauma 2021; 12:123-9. [PMID: 33716437 DOI: 10.1016/j.jcot.2020.09.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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
|
11
|
Kim CS, Jang K, Leem JG, Shin JW, Kim DH, Choi SS. Factors associated with Successful Responses to Ganglion Impar Block: A Retrospective Study. Int J Med Sci 2021; 18:2957-2963. [PMID: 34220323 PMCID: PMC8241784 DOI: 10.7150/ijms.60962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/24/2021] [Indexed: 11/05/2022] Open
Abstract
Background: The ganglion impar (ganglion of Walther) block has been used to manage coccygeal and perineal (perianal and genital) pain due to both benign and malignant causes. However, the factors associated with successful responses to ganglion impar block are unknown. Therefore, in the present study, we aimed to identify the independent factors associated with successful responses to ganglion impar block in patients with chronic pain in coccygeal and perineal regions. Methods: From January 2008 to December 2017, we performed a retrospective review of 106 patients who underwent ganglion impar block. Patients were considered successful responders if they reported a decrease of more than 50% or 4 points on the 11-point (0 = no pain and 10 = worst possible pain) numerical rating scale 1 month after the procedure, while others were considered non-responders. Logistic regression analysis was performed to identify factors independently associated with successful responses at 1 month after the procedure. Results: Multivariable logistic regression analysis showed that cancer-related causes were significantly associated with successful responses at 1 month after ganglion impar block (odds ratio = 2.60, 95% confidence interval = 1.05 to 6.43, P = 0.038). Conclusion: Ganglion impar block may be more effective in cancer-related pain than pain due to benign causes.
Collapse
Affiliation(s)
- Chan-Sik Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Kyounghwan Jang
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jeong-Gil Leem
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jin-Woo Shin
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Doo-Hwan Kim
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Seong-Soo Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
12
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
13
|
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
|
14
|
Foye PM, Jason WTK, Zheng KY, Leong KK. Low incidence of vascular uptake during ganglion impar sympathetic nerve blocks for coccydynia. Indian J Radiol Imaging 2020; 30:181-183. [PMID: 33100686 PMCID: PMC7546296 DOI: 10.4103/ijri.ijri_302_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/23/2019] [Accepted: 02/20/2020] [Indexed: 11/29/2022] Open
Abstract
Context: Focal sympathetic nerve blocks of the ganglion impar are often effective treatments for coccydynia (coccyx pain) and other pelvic pain syndromes. These injections are generally performed under contrast-enhanced fluoroscopic guidance. Vascular uptake may potentially occur during the injection and vascular uptake rates have been reported for other spinal injections, but never for ganglion impar blocks. Aims: The purpose of the study was to determine vascular uptake rates during fluoroscopy-guided ganglion impar blocks. Settings and Design: An academic/University-based Coccyx Pain Center. Methods and Materials: A total of 78 consecutive trans-coccygeal ganglion impar blocks were analyzed for vascular uptake of contrast as determined by intermittent fluoroscopy. Statistical Analysis Used: Direct calculation of incidence. Results: Only one patient (1.3%) demonstrated a vascular uptake pattern, which was readily recognized and corrected by slightly adjusting the position of the needle tip and thereby subsequently obtaining the desired contrast pattern at the ganglion impar. Conclusions: Vascular uptake incidence is low during ganglion impar blocks. This information can be one of the multiple factors considered when a physician is deciding whether or not to use contrast in an individual patient.
Collapse
Affiliation(s)
- Patrick M Foye
- Coccyx Pain Center, Rutgers New Jersey Medical School, Newark, New Jersey, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Woon T K Jason
- School of Medicine, The University of Auckland, Auckland, New Zealand
| | - Kevin Y Zheng
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| | - Kenneth K Leong
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, United States
| |
Collapse
|
15
|
Abstract
Background: Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic. Percutaneous vertebroplasty and sacroplasty are the methods that are widely used for treating compression fractures and sacral insufficiency fractures, respectively. However, the success of polymethylmethacrylate injection in the treatment of osteoporotic coccyx fractures and coccydynia is still unknown. Case Report: A 68-year-old man was admitted to our clinic with complaints of pain in the sacrococcygeal and perianal regions. In the imaging studies, a fracture line in the fifth sacral and first coccygeal segments was observed as evidenced by a bony edema. Since the patient’s pain did not improve with conservative methods, we treated him with coccygeoplasty. No complication was encountered. The day after the operation, he was discharged from the hospital with complete pain relief. The patient confirmed having no pain on the third postoperative month and so did not need any analgesics. Conclusion: Coccyceoplasty may be a good treatment option for retractable pain in patients with acute or subacute osteoporotic coccygeal fractures and coccydinia with edema.
Collapse
Affiliation(s)
- Ezgi Akar
- Clinic of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Orkun Koban
- Department of Neurosurgery, Okan University School of Medicine, İstanbul, Turkey
| | - Ahmet Öğrenci
- Department of Neurosurgery, Okan University School of Medicine, İstanbul, Turkey
| | - Mesut Yılmaz
- Department of Neurosurgery, Neurospinal Academia, İstanbul, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Okan University School of Medicine, İstanbul, Turkey
| |
Collapse
|
16
|
Koné N. About an observation of coccydynia treated by surgery. Pan Afr Med J 2020; 36:135. [PMID: 32849990 PMCID: PMC7422743 DOI: 10.11604/pamj.2020.36.135.19904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 03/19/2020] [Indexed: 11/11/2022] Open
Affiliation(s)
- Noukhoum Koné
- Service de Neurochirurgie, Centre Hospitalier de Kiffa, Kiffa, Mauritanie
| |
Collapse
|
17
|
Lyon KA, Huang JH, Garrett D. Influence of psychiatric disorders and chronic pain on the surgical outcome in the patient with chronic coccydynia: a single institution's experience. Neurol Res 2020; 42:789-794. [PMID: 32496925 DOI: 10.1080/01616412.2020.1775014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Performing coccygectomy procedures on patients with psychiatric disorders and/or chronic low back pain have been previously thought of as contributing factors leading to inconsistent and often poor results. To determine if these two variables affect the post-operative pain relief obtained after coccygectomy, an analysis of the opioid requirements and pain descriptions before and after surgery was undertaken in each patient studied. METHODS The hospital electronic medical records were searched, and only patients undergoing coccygectomy for chronic coccydynia were selected. A total of 8 patients were found. Each patient underwent a trial of conservative therapy prior to surgical evaluation. RESULTS The average duration of symptoms prior to surgery was 41.3 months. In 7 out of 8 patients, at least one psychiatric disorder was present. In 6 out of 8 patients, chronic low back pain was present. Pain control with opioid-based medicines was required in 5 out of 8 patients prior to surgery. Of those, 4 were able to discontinue or reduce the amount of opioid-based medicines consumed after surgery. The average follow-up was 9 months. DISCUSSION The results of this study indicate that patients with preexisting psychiatric disorders and/or chronic low back pain suffering from debilitating coccyx pain can obtain pain relief after coccygectomy as seen from a reduction in opioid requirements and pain burden. It should be noted that the obtained benefits from coccygectomy usually occur in a delayed fashion.
Collapse
Affiliation(s)
- Kristopher A Lyon
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center , Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine , Temple, TX, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center , Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine , Temple, TX, USA
| | - David Garrett
- Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center , Temple, TX, USA.,Department of Surgery, Texas A&M University College of Medicine , Temple, TX, USA
| |
Collapse
|
18
|
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
|
19
|
Gönen Aydın C, Örsçelik A, Gök MC, Akman YE. The Efficacy of Extracorporeal Shock Wave Therapy for Chronic Coccydynia. Med Princ Pract 2020; 29:444-450. [PMID: 31918431 PMCID: PMC7511685 DOI: 10.1159/000505835] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/09/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Coccydynia is a disorder that decreases quality of life with significant functional failure. Extra-corporeal shock wave therapy (ESWT) is used to treat several painful musculoskeletal disorders. SUBJECTS AND METHODS The medical records of 34 patients (29 females, 5 males) who had been treated with ESWT between 2017 and 2018 for chronic coccydynia were evaluated. Visual analog scale (VAS) scores were noted at the initial consultation, at each session, and during the initial and follow-up (at 6 months) examinations after the treatment. The 36-item short form (SF-36) quality of life scale survey was conducted at the beginning and end of the treatment. MRI was performed before the start of the procedure and 1 month after the end of the treatment. RESULTS The mean VAS score was 9.6 (9-10) before the treatment and 3.4 (0-2) after the treatment (p < 0.05). The VAS score decreased to ≤3 in 79.4% of patients. Bone marrow edema regressed in 6% of patients. Significant improvement was observed in all of the SF-36 parameters, except for two. CONCLUSION In our patient group, ESWT provided effective pain control. In order to evaluate the efficacy of ESWT more accurately and sensitively, prospective randomized studies with longer follow-up periods, in which ESWT is compared with different energy doses and different treatment methods, are needed.
Collapse
Affiliation(s)
- Canan Gönen Aydın
- Department of Sports Medicine, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey,
| | - Aydan Örsçelik
- Department of Sports Medicine, University of Health Sciences Gülhane Faculty of Medicine, Istanbul, Turkey
| | - Mustafa Cantay Gök
- Department of Radiology, Metin Sabanci Baltalimani Bone Diseases Training and Research Hospital, Istanbul, Turkey
| | - Yunus Emre Akman
- Private Practice in Orthopedics and Traumatology, Istanbul, Turkey
| |
Collapse
|
20
|
Abstract
BACKGROUND This case series describes, for the first time, to the author's knowledge, a novel treatment for coccydynia. Tarsal tunnel block with lignocaine only brought relief of chronic coccydynia lasting more than 6 months in three patients. The author adopts the theory that the myelin sheath of the posterior tibial nerve will convey the lipid-soluble lignocaine upward toward the dorsal root ganglia and the nerve roots of the lumbar spine through the uninterrupted myelin sheath, which is itself mainly formed of lipids. The author thinks that most coccyx pain is actually a radiating pain from the lumbar spine, which is not always apparent on magnetic resonance imaging of the lumbar spine. Certainly, the author acknowledges that large-scale studies need to be done to prove the efficacy of this new technique and to prove that the myelin sheath can convey the lignocaine chemical upward. CASE PRESENTATION Three Arab patients presented with chronic coccydynia of more than 6 months' duration in whom conservative management had failed to control their symptoms. They had no past medical history of significance and no history of trauma. The results of physical examination of all of the patients were normal apart from tenderness on palpation of the coccyx. They all received local coccyx injection with steroids on two occasions, which failed to relieve their pain. One patient underwent manipulation under anesthesia, and one underwent coccygectomy with no pain relief. Magnetic resonance imaging results were reported to be normal in two of them, whereas the other one had a prolapsed disc at the L4/L5 level. The three patients described pain relief 30 minutes after tarsal tunnel block with lignocaine only lasting more than 6 months. All patients had heel anesthesia 15 minutes after the tarsal tunnel injection, which lasted only 1 hour. CONCLUSIONS Tarsal tunnel block with lignocaine can relieve coccyx pain for a long time. Tarsal tunnel block can be done to achieve heel anesthesia before injection of lignocaine into the plantar fascia in patients with plantar fasciitis.
Collapse
|
21
|
Maigne JY, Doursounian L, Jacquot F. Classification of fractures of the coccyx from a series of 104 patients. Eur Spine J 2020; 29:2534-42. [PMID: 31637549 DOI: 10.1007/s00586-019-06188-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 10/02/2019] [Accepted: 10/13/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE To describe a classification of fractures of the coccyx, according to their mechanism. METHODS A series of 104 consecutive patients with a fracture of the coccyx was studied. The mechanism, level, characteristics of the fracture line and complications were recorded. RESULTS Three mechanisms are proposed to describe these fractures: flexion, compression and extension (types 1, 2 and 3, respectively). Flexion fractures (38 cases) involved the upper coccyx in 35 cases, and in 3 cases with a perineal trauma, it was the lower coccyx; compression fractures (24 cases) involved the middle coccyx and occurred only when Co2 was square or cuneiform and Co3 was long and straight, hence a nutcracker mechanism; four patients were adolescents with a compression of the sacrum extremity and were labeled adolescent compression fracture of S5 (type 2b); extension fractures (38 cases) were obstetrical and involved the lower coccyx; their key feature was a progressive separation of the fragments with time. Flexion fractures usually healed spontaneously, but an associated intermittent luxation was possible. Nutcracker and obstetrical fractures were instable in their majority. CONCLUSIONS For the first time, a classification of fractures of the coccyx is presented. Each type exhibits specific features. This should help the clinician in the management of these patients. These slides can be retrieved under Electronic Supplementary Material.
Collapse
|
22
|
Dayawansa S, Garrett D, Wong M, Huang JH. Management of coccydynia in the absence of X-ray evidence: Case report. Int J Surg Case Rep 2018; 54:63-65. [PMID: 30529808 PMCID: PMC6282188 DOI: 10.1016/j.ijscr.2018.11.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND IMPORTANCE Coccydynia is a rare pain syndrome due to trauma to the coccyx that is diagnosed through history, physical, and sitting/standing lateral plain film radiographs. Coccydynia is typically managed conservatively with specialized cushions, NSAIDS, and physical therapy. In cases refractory to nonsurgical management, coccygectomy has a high success rate for pain reduction. CLINICAL PRESENTATION Our patient had coccygeal pain for three years and endorsed a mobile fragment that was not highlighted on plain film radiographs. After evaluation with MRI and CT, a coccygeal source of their pain was highlighted and partial coccygectomy was performed. CONCLUSION Post-operatively, patient endorsed major improvement in her pain at follow up. In a case of suspected coccydynia where initial imaging is inconclusive but clinical suspicion is very high, higher level imaging such as MRI or CT can reveal radiographic findings of coccydynia. MRI and CT can play a role in the diagnosis and treatment of coccydynia in the absence of x-ray evidence.
Collapse
Affiliation(s)
- Samantha Dayawansa
- Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, USA.
| | - David Garrett
- Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, USA
| | - Marcus Wong
- Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, USA
| | - Jason H Huang
- Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, USA
| |
Collapse
|
23
|
Seker A, Sarikaya IA, Korkmaz O, Yalcin S, Malkoc M, Bulbul AM. Management of persistent coccydynia with transrectal manipulation: results of a combined procedure. Eur Spine J 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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
24
|
Abstract
BACKGROUND In the past, few studies have been done to objectively measure the sacrococcygeal (SC) and intercoccygeal (IC) angles in the population and in patients with coccydynia. Coccydynia is an age-old disorder, the exact incidence of which has not been determined. It is reported to be more common in females and the obese. The magnetic resonance imaging (MRI) studies done in the past have calculated the curvature indices. In this study, we used MRI to objectively measure the angles in the normal participants as well as those with idiopathic coccydynia. MATERIALS AND METHODS Two groups of patients were identified. Group A was "control group" of 106 normal participants and Group B comprised "study group" of ten patients suffering from idiopathic coccydynia. In all these patients, midsagittal T1-weighted MRI image acquired in supine position was used to calculate SC and IC angles. Data were analyzed, and angles were compared between the study and control groups. Statistical analysis was done with Chi-square test. RESULTS In the control group, the average SC and IC angles in the control group were 126.8° and 33.5°, respectively. In the study group, the average SC angle and the average IC angle turned out to be 127.1° and 43.2°, respectively. The difference between the SC angles in the control and study groups was not significant (P = 0.7), whereas the difference between the IC angles in the two groups was significant (P = 0.002). CONCLUSIONS From our study, we observed that the IC angle shows a decreasing trend with increasing age. In addition, increased IC angle was identified as a possible cause of idiopathic coccydynia.
Collapse
Affiliation(s)
- Vishal Gupta
- Department of Radiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India,Address for correspondence: Dr. Vishal Gupta, Department of Radiology, School of Medical Sciences and Research, Sharda University, Greater Noida - 201 306, Uttar Pradesh, India. E-mail:
| | - Neema Agarwal
- Department of Radiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| | - Barin Prasad Baruah
- Department of Radiology, School of Medical Sciences and Research, Sharda University, Greater Noida, Uttar Pradesh, India
| |
Collapse
|
25
|
Kodumuri P, Raghuvanshi S, Bommireddy R, Klezl Z. Coccydynia - could age, trauma and body mass index be independent prognostic factors for outcomes of intervention? Ann R Coll Surg Engl 2017; 100:12-15. [PMID: 29260897 DOI: 10.1308/rcsann.2017.0089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. All patients who presented to the Royal Derby Hospital with a primary diagnosis of coccydynia between January 2011 and January 2015 who had injections, manipulation under anaesthesia or coccygectomy were included. We used patient-reported satisfaction score as the primary outcome measure. We hypothesised that patients with preceding history of trauma and with high BMI (> 25) would be less satisfied. We divided patient BMI into four groups, following World Health Organization guidelines: group A (18.5-24.9), group B (25-29.9), group C (30-39.9) and group D (> 40). Results A total of 748 patients were diagnosed with coccydynia. Of these, 201 patients had 381 injections, 40 had 98 manipulations under anaesthesia and 9 had coccygectomy. Mean age was 46.4 years; 26% of patients had trauma to the coccyx. The mean time to follow-up was 7.3 months. We found a statistically significant difference (P = 0.03) between satisfaction scores in groups B and D. Patients who had trauma improved significantly (P = 0.04). The odds ratio calculation of coccygectomy and BMI revealed a higher risk of coccygectomy in Group A. Discussion This is the first study to establish BMI and trauma as independent prognostic factors for coccydynia treatment. Our hypothesis that patients with higher BMI would have lower satisfaction levels has been proven true.
Collapse
Affiliation(s)
| | | | | | - Z Klezl
- Royal Derby Hospital , Derby , UK
| |
Collapse
|
26
|
Tejón P, Belmonte MA, Lerma JJ, Lozano A. Coccydynia related to the use of a contraceptive vaginal ring. Reumatol Clin 2017; 13:42-43. [PMID: 26805547 DOI: 10.1016/j.reuma.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 11/05/2015] [Accepted: 11/20/2015] [Indexed: 06/05/2023]
Abstract
Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system.
Collapse
Affiliation(s)
- Patricia Tejón
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España.
| | - Miguel Angel Belmonte
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España
| | - Juan José Lerma
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España
| | - Antonio Lozano
- Sección de Reumatología, Hospital Universitario General de Castellón, Castellón de la Plana, Castellón, España
| |
Collapse
|
27
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|
28
|
Gaike CV, Kanna RM, Shetty AP, Rajasekaran S. A rare cause of recalcitrant coccydynia: benign dermoid cyst masquerading as coccygeal pain. Eur Spine J 2015; 25 Suppl 1:194-7. [PMID: 26649554 DOI: 10.1007/s00586-015-4354-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Coccydynia is a common entity in orthopedic practice, and various etiologies have been described for it. However, benign dermoid cyst causing coccydynia has not yet been reported. METHODS A 20-year-old male presented with typical symptoms of coccydynia recalcitrant to conservative treatment for 2 years. Since pain interfered with his daily activities, magnetic resonance imaging was performed which showed a circumscribed precoccygeal cystic lesion. RESULTS The patient underwent coccygectomy along with cyst excision. Histological examination revealed features of benign dermoid cyst. After surgery, the patient had excellent relief of his symptoms. CONCLUSION The case report identifies that the treating surgeon should be aware of benign dermoid cyst as one of the treatable but rare causes of intractable coccydynia, and MRI should be performed in patients with persistent coccygeal pain.
Collapse
Affiliation(s)
- Chandrasekhar V Gaike
- Orthopedics Department, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Rishi M Kanna
- Orthopedics Department, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - Ajoy P Shetty
- Orthopedics Department, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India
| | - S Rajasekaran
- Orthopedics Department, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu, 641043, India.
| |
Collapse
|
29
|
Foye PM, Desai RD. MRI, CT scan, and dynamic radiographs for coccydynia: comment on the article "role for magnetic resonance imaging in coccydynia with sacrococcygeal dislocation", by Trouvin et al., Joint Bone Spine 2013;80:214-16. Joint Bone Spine 2014; 81:280. [PMID: 24462128 DOI: 10.1016/j.jbspin.2013.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/12/2013] [Indexed: 10/25/2022]
Affiliation(s)
- Patrick M Foye
- Coccyx Pain Center, Rutgers New Jersey Medical School, 90, Bergen St, D.O.C. Suite 3100, Newark, 07103-2425 Newark, NJ, USA.
| | - Raj D Desai
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| |
Collapse
|
30
|
Howard PD, Dolan AN, Falco AN, Holland BM, Wilkinson CF, Zink AM. A comparison of conservative interventions and their effectiveness for coccydynia: a systematic review. J Man Manip Ther 2014; 21:213-9. [PMID: 24421634 DOI: 10.1179/2042618613y.0000000040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
STUDY DESIGN Systematic literature review. OBJECTIVE To investigate the various conservative interventions for coccydynia and determine their effectiveness. BACKGROUND Coccydynia is the term used to describe pain in the coccygeal region. Pain in this region is typically caused by local trauma. Sitting is typically the most painful position for patients having coccydynia. Various methods of treating coccydynia are found in the literature but to our knowledge no systematic review has been performed that compared the effectiveness of these interventions. METHODS Searches were performed for research studies using electronic databases (Cochrane Library, CINAHL, Medline, PEDro, Scopus, and Sports Discus) from January 2002 through July 2012. The quality of the papers was assessed using the GRADE approach. RESULTS Seven papers were located that satisfied the inclusion and exclusion criteria (2 RCTs, 5 observational studies). The level of evidence ranged from moderate to very low quality and recommendations for use ranged from weak recommendations for use to weak recommendations against use. CONCLUSIONS Due to the dearth of research available and the low levels of evidence in the published studies that were located we are unable to recommend the most effective conservative intervention for the treatment of coccydynia. Additional research is needed regarding the treatment for this painful condition.
Collapse
Affiliation(s)
- Paul D Howard
- Department of Physical Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Andrea N Dolan
- Department of Physical Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anthony N Falco
- Department of Physical Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brett M Holland
- Department of Physical Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Caitlin F Wilkinson
- Department of Physical Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| | - Anna M Zink
- Department of Physical Therapy, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA, USA
| |
Collapse
|
31
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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
|