The painful coccyx

Article · January 1978with 25 Reads 
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Abstract
An understanding of the anatomy of the coccyx and its joints is helpful in evaluating its disorders. Injury and disease of the coccyx are subject to accurate diagnosis, as are any other bone and joint disorders. Lesions of the coccyx are comparable with those of other parts of the skeletal system. Traumatic osteoarthritis and sprain are the most common disorders of the coccygeal joints. True psychoneurosis related to the coccyx is rare. Pain in the coccyx can be relieved usually by removal of the weight from this area in sitting, aided by physical therapy. Persistent pain in the coccyx may be relieved by coccygectomy, but the operation should be chosen carefully and performed well.

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  • ... 5 Prolotherapy (proliferative therapy) induces inflammation and subsequently the formation of a stable scar in the ligaments and soft tissues that may be responsible for reducing pain. Prolotherapy in coccygodynia is well reported, 2 Table Visual analogue scores of pain in patients undergoing prolotherapy widely accepted protocol for prolotherapy treatment of coccygodynia. In a study reporting 200 patients with coccygodynia, prolotherapy of chronic, nonresponding coccygodynia was not the focus, though the authors did conclude that coccygectomy was effective in those with intractable coccygeal pain. 1 In another study, coccygectomy was successful in 90% of the 120 patients undergoing this procedure for chronic, non-responding coccygodynia. ...
    Article
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    To present the results of dextrose prolotherapy undertaken for chronic non-responding coccygodynia in 37 patients. 14 men and 23 women (mean age, 36 years) with chronic coccygodynia not responding to conservative treatment for more than 6 months were included. 27 of them had received local steroid injections. A visual analogue score (VAS) was recorded for all patients before and after injection of 8 ml of 25% dextrose and 2 ml of 2% lignocaine into the coccyx. In 8 patients with a VAS of more than 4 after the second injection, a third injection was given 4 weeks later. The mean VAS before prolotherapy was 8.5. It was 3.4 after the first injection and 2.5 after the second injection. Minimal or no improvement was noted in 7 patients; the remaining 30 patients had good pain relief. Dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. Randomised studies are needed to compare prolotherapy with local steroid injections or coccygectomies.
  • ... The word "coccyx" is derived from Greek; it refers to a cuckoo's beak, which resembles the anatomy of the curved coccygeal terminus [1]. Coccygodynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity [2]. ...
    Article
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    Study DesignRetrospective cohort study.PurposeTrauma is the most common cause for chronic coccygodynia. The present study aims at presenting our results after complete removal of the coccyx for refractory traumatic coccygodynia in terms of pain level, complication rates, and patients' overall satisfaction.Overview of LiteratureThere is limited extant literature describing the success rate and complications in refractory isolated traumatic coccygodynia.Methods From January 2011 to January 2012, 10 consecutive patients with posttraumatic coccygodynia (six males and four females; mean age, 42 years) were enrolled in our study. Conservative treatment of the condition had failed in all patients. The same surgeon performed a complete coccygectomy on all patients. Postoperative outcomes included measurements of pain relief and degree of patient satisfaction with the procedure's results.ResultsIn our selected cohort, all patients indicated complete pain relief or significant pain improvement in follow up-care and would recommend this procedure. One patient developed a subcutaneous hematoma that required surgical intervention.Conclusions Our results suggest that complete removal of the coccyx relieves pain in patients with refractory chronic traumatic coccygodyniaand is therefore a reasonable treatment option after conservative treatment failure.
  • ... The term "coccyx" is derived from the Greek word for the beak of a cuckoo bird because of the similarity in appearance when the latter is viewed from the side. [1][2][3] Coccygodynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity. [4] Notably, when a seated individual leans back, the weight load is borne almost entirely by the coccyx and gives rise to classic pain syndrome when a person leans backward. ...
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    Introduction Coccygodynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity. The pain is usually provoked by sitting or rising from sitting. Several studies have reported good or excellent results after coccygectomy especially in patients who are refractory to conservative treatment. Aims and Objectives This study aims to evaluate the role and effectiveness of coccygectomy in chronic refractory coccygodynia. Materials and Methods Between January 2011 and January 2015, 16 consecutive patients (4 males and 12 females) who underwent surgical coccygectomy were enrolled prospectively in the study. All patients suffered from treatment-resistant coccygodynia and had exhausted conservative therapeutic options for at least 6 months before undergoing surgery. The same surgeon performed a complete coccygectomy on all patients. Postoperative outcomes included measurements of pain relief and degree of patient satisfaction with the procedure's results. Results The average age of patient was 37.93 years (range: 25–53 years), and the male to female ratio was 1:3. The median duration of patient-reported symptoms prior to surgery was 24 months. The most common cause of coccygodynia was direct or indirect trauma, recorded in 11 patients (68.75%). Idiopathic coccygodynia was five cases (31.25%). The number of patients with outcomes rated as “excellent,” “good,” “fair,” and “poor” were 12, 2, 1, and 1, respectively. The favorable result (excellent or good) was 87.5%. The self-reported visual analog scale (VAS) was significantly improved by surgery. The mean VAS preoperatively was 9.62, and postoperatively it was 2.25 (P < 0.001). There were two infections (12.5%) among the 16 patients which were managed conservatively. Conclusions Coccygectomy for chronic intractable coccygodynia is simple and effective, with a low complication rate.
  • ... The coccyx, often implicated in CPP (Howorth, 1959), articulates with the 5th sacral vertebrae via the sacrococcygeal junction. It receives its innervation from the coccygeal plexus with contributions described as arising primarily from the L4-5 ventral rami and the coccygeal ventral rami. ...
    Article
    The multisystem nature of female chronic pelvic pain (CPP) makes this condition a challenge for physical therapists and other health care providers to manage. This article uses a case scenario to illustrate commonly reported somatic, visceral, and neurologic symptoms and their associated health and participation impact in a female with CPP. Differential diagnosis of pain generators requires an in-depth understanding of possible anatomic and physiologic contributors to this disorder. This article provides a detailed discussion of the relevant clinical anatomy with specific attention to complex interrelationships between anatomic structures potentially leading to the patient's pain. In addition, it describes the physical therapy management specific to this case, including examination, differential diagnosis, and progression of interventions. Clin. Anat., 2012. © 2012 Wiley Periodicals, Inc.
  • ... Coccydynia (coccygalgia or coccygodynia) is defined as pain in or around the tail bone area (oscoccygis; coccyx). The term coccydynia was first used by Simpson (1) in 1859, but descriptions of pain in the terminal portion of the spine date back to at least 16 th and 17 th centuries (2)(3)(4)(5). However, despite being recognised for many centuries, coccydynia remains an unsolved mystery because of the perceived uncertainty in identifying the origin of the pain (1). ...
    Article
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    Coccydynia is defined as pain in or around the tail bone area. The most common cause of coccydynia is either a trauma such as a fall directly on to the coccyx or repetitive minor trauma. The etiology remains obscure in up to 30% of patients. The literature on the contribution of rheumatic diseases to coccydynia is scarce. Our objective was to investigate the prevalence of coccydynia in ankylosing spondylitis (AS) patients. One hundred and seven consecutive patients with AS were evaluated for coccydynia were enrolled between January and November 2012 for a cross-sectional analysis. Seventy-four consecutive patients were followed for mechanical back pain as controls and the AS patients were interviewed for the presence of coccydynia. The data collected was evaluated on SPSS® version 11.5 and Microsoft Excel® Programmes. Prevalence of coccydynia in AS (38.3%) was significantly higher than the control group (p<0.0001) in both female and male AS patients (female AS vs. control=40.9% vs. 18.4%, p=0.015 and male AS vs. control=36.5% vs. 8.0%, p=0.005). Both genders were affected equally in the AS group whereas coccydynia was slightly more frequent in female patients in the control group. Coccydynia is a previously neglected symptom of AS and it is almost three times more common in AS than in non-specific chronic low back pain. Our observation may implicate that inflammatory diseases have a role in the etiology of coccydynia, especially in those without a history of recent or past trauma and coccydynia may be a factor associated with the severity of AS as well.
  • ... Local injection of corticosteroid and lidocaine is a simple therapeutic option that should be tried before operation. (2)(3)(4)(5). ...
    Article
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    Severe coccygodynia is often treated with coccygectomy. In Norway, conservative treatment is usually restricted to avoiding pressure on the painful area. We have used local injection with a mixture of corticosteroid and lidocaine in this condition. We present 11 patients with coccygodynia treated with local injection. All patients were contacted by telephone three or more years later. At follow-up, one patient was asymptomatic, five patients had improved so much that further treatment was unnecessary, and in one patient the condition was unchanged. Four patients had been operated during the follow-up period. Local injection of corticosteroid and lidocaine is a simple therapeutic option that should be tried before operation.
  • ... Hace más confortable la sedestación (que solo existe en el hombre). El estudio de su patología permite constatar como lo había intuido Howorth (21) , que las lesiones que originan la coccigodinia son, en su mayoría, lesiones parecidas a las que afectan a las articulaciones periféricas, y no problemas psiquiátricos desatendidos por el paciente. ...
    Article
    Introducción Si la primera descripción de un dolor de coxis ocasionado por una fractura se debe a Ambroise Paré (1) , cirujano francés del siglo XVI, fue Simpson quién le dio el nombre de coccigodinia (1859). Esta afección a dado lugar a numerosos trabajos, pero por mucho tiempo ha sido un misterio. Recurrir a las Rx dinámicas, descritas por nosotros en 1992, ha permitido comprender mejor las posibles diferentes causas de esta afección, sus síntomas particulares, y abordar un tratamiento racional. Clamator Glandarius, el cucut egipcio, que ha dado nombre al coxis, por la forma de su pico.
  • ... 26 Affected patients are commonly females in their 30s or 40s. 3,11 Direct or indirect trauma to the coccygeal bone can induce chronic coccygodynia. The most frequent accident mechanism is axial impact to the most distal part of the spine. ...
    Article
    Direct or indirect trauma to the coccygeal bone can induce chronic coccygodynia. The aim of this study is a retrospective analysis of our patients surgically managed for traumatic coccygodynia and a critical review of the results obtained in comparison to the literature. We have retrospectively investigated patients with traumatic coccygodynia referred to our centre after a failure of conservative treatment. Surgery (coccygectomy) was performed in 74 patients (64 women, 10 men) suffering from coccygodynia resistant to conservative treatment, all without serious complications, between the years 1998 and 2004. The mean follow up was 4.1 years (range, 2-8 years). The mean age of patients on the date of surgery was 43.4 years (range, 16-65 years). The average duration of pain prior to surgery was 7 months (range, 3 months to one year). All but three patients had either good or excellent results after surgery. Three patients reported postoperative pain lasting 3-6 months. All three had good results after re-operation of a proximal segment without excision. Five postoperative complications, four superficial and one deep infection were observed. In patients with posttraumatic, conservative therapy-resistant coccygodynia, operative treatment with coccygectomy is a feasible management option. We recommend total or partial coccygectomy using a longitudinal incision in carefully selected and well-informed patients.
  • ... [1] As the symptoms become chronic, patients fi nd their daily activities becoming painful. Many patients are labeled as having somatization or "functional" [2] pain and are not taken seriously. Also, in Indian traditional medicine the pelvis is regarded as the area where emotional and physical stress is buried-muladhar chakra. ...
    Article
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    Patients who are diagnosed clinically as Coccygodynia often do not get satisfactory relief. The clinical diagnosis is based on various hypotheses that have been proposed to explain the pain of coccydynia - including coccygeal spicules, pain from the pericoccygeal soft tissues, pelvic floor muscle spasm, referred pain from lumbar pathology, arachnoiditis of the lower sacral nerve roots, local posttraumatic lesions, somatization, etc. The diagnosis is difficult and the pathophysiology is poorly understood. Till recently, use of dynamic X-rays and MRI imaging was not considered to diagnose this condition. The author would like to report three patients who presented to the pain clinic with refractory coccygeal pain and underwent dynamic coccyx X-rays and MRI as part of their evaluation. All these patients had positive findings on MRI. These patients were treated satisfactorily as a result of the added diagnostic value of MRI.
  • ... The word 'coccyx' has its ancestry from the Greek word used the beak of the cuckoo bird due to remarkable resemblance in appearance when viewed from the side [1][2][3]. ...
    Article
    Full-text available
    Coccydynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity. The pain is usually provoked by sitting or rising from sitting. Most cases are associated with abnormal mobility of the coccyx, which may trigger a chronic inflammatory process leading to degeneration of this structure. The exact incidence of coccydynia has not been reported; however, factors associated with increased risk of developing coccydynia include obesity and female gender. Several non operative interventions are currently used for the management of coccydynia including Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), hot baths, ring-shaped cushions, intrarectal massage and manipulation (manual therapy), steroid injection, dextrose prolotherapy, ganglion impar blocks, pulsed Radio Frequency Thermocoagulation (RFT) and psychotherapy. Several studies have reported good or excellent results after coccygectomy especially in patients who are refractory to conservative treatment.
  • ... Since the human coccyx is considered a vestigial remnant of a tail, it is also referred to as the tailbone. The word coccyx is derived from the Greek word for cuckoo, since that portion of the spine resembles a cuckoo's beak [1]. The human coccyx is variably composed of three to five individual segments or vertebrae. ...
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    Study Design A retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population. Purpose There have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population. Overview of Literature Coccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations. Methods A retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type. Results Types I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females. Conclusions Type I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.
  • ... Several authors [1][2][3][4][5][6][7] have reported excellent or good results in 60% to 90% of the cases treated by operation (Table I), but these studies are retrospective, and the criteria for selection of the patients are ill-defined. Howorth 8 suggested that excision was advisable when there was a clear indication, such as a stiff coccyx in a badly deformed position or a diseased bone. Bayne et al 1 found ...
  • Article
    Randomized open study. To evaluate the efficacy of intrarectal manual treatment of chronic coccydynia; and to determine the factors predictive of a good outcome. In 2 open uncontrolled studies, the success rate of intrarectal manipulation of the coccyx was around 25%. Patients were randomized into 2 groups of 51 patients each: 1 group received three sessions of coccygeal manipulation, and the other low-power external physiotherapy. The manual treatment was guided by the findings on stress radiographs. Patients were assessed, at 1 month and 6 months, using a VAS and (modified) McGill Pain, Paris (functional coccydynia impact), and (modified) Dallas Pain questionnaires. At baseline, the 2 groups were similar regarding all parameters. At 1 month, all the median VAS and questionnaire values were modified by -34.7%, -36.0%, -20.0%, and -33.8%, respectively, in the manipulation group, versus -19.1%, -7.7%, 20.0%, and -15.7%, respectively, in the control (physiotherapy) group (P = 0.09 [borderline], 0.03, 0.02, and 0.02, respectively). Good results were twice as frequent in the manipulation group compared with the control group, at 1 month (36% vs. 20%, P = 0.075) and at 6 months (22% vs. 12%, P = 0.18). The main predictors of a good outcome were stable coccyx, shorter duration, traumatic etiology, and lower score in the affective parts of the McGill and Dallas questionnaires. We found a mild effectiveness of intrarectal manipulation in chronic coccydynia.
  • Article
    Severity of vertical impact to the coccyx can range from mere contusion to a dislocated fracture of the coccyx. With early conservative management, most patients have a good prognosis and heal within weeks to months after the initial trauma. Occasionally, persisting symptoms make a surgical intervention with coccygectomy necessary. We report on the results of patients surgically managed for traumatically induced, persisting coccygodynia and compare these to patients operatively treated for idiopathic coccygodynia. Sixteen patients with an average follow-up of 7.3 years were evaluated. Of these, eight were surgically treated for traumatic and eight for idiopathic coccygodynia. The clinical results were assessed by means of the Hambly Score and the Oswestry Low Back Pain Disability questionnaire. Patient satisfaction with the postoperative result was assessed by a visual analog scale. Seven of eight (88%) patients treated for traumatically induced coccygodynia had a good or excellent postoperative result, in contrast to only three of eight (38%) patients with idiopathic coccygodynia. The former group had better results in terms of sitting tolerance and general pain intensity as represented by the Oswestry Low Back Pain Disability questionnaire. According to the significantly better clinical results, personal satisfaction was clearly higher in the traumatic group. These results suggest that, in patients where all conservative treatment methods work to no avail, particularly those with traumatically induced persisting coccygodynia benefit from surgical intervention with coccygectomy.
  • Article
    Few data exist comparing the surgical and nonsurgical treatment of coccygodynia. We sought to retrospectively review our experience with coccygectomy compared with injections for the relief of coccygodynia to determine rates of success and patient satisfaction and identify complications. From March 1993 to January 2002, 51 consecutive patients with the diagnosis of coccygodynia were evaluated. All of the patients complained of pain while sitting and had localized pain to external and internal palpation of the coccyx on physical examination. Nonoperative treatment (medications, cushions, therapy) had failed to relieve the patients' symptoms. All patients were seen in follow-up for physical examination and completed a questionnaire by an independent examiner. Follow-up of the patients was 26 months (range 12-59 months). Follow-up data were available on 45 of the 51 enrolled. The patients were divided as follows: 20 patients were treated with total coccygectomy and 25 patients were treated with injection therapy. Of those treated operatively, 18 patients (90%) felt improved and were satisfied with the procedure. Two patients felt their symptoms to be unchanged and were dissatisfied. Postoperative complications included seven wound problems: four superficial infections and three patients with persistent drainage. All resolved with local wound care and oral antibiotics. No further surgery was necessary. There were no bowel injuries and no reports of sphincter problems. Of those treated with injections, 5 of the 25 (20%) felt improvement and were satisfied. Sixteen (64%) were not improved, and four (16%) felt worse. Five (20%) eventually were treated with coccygectomy, four with satisfactory relief in symptoms. Despite the potential for wound problems, coccygectomy for relief of coccygodynia can be a safe and effective treatment option with a high patient satisfaction rate. Wound closure and postoperative wound care are of utmost importance.
  • Article
    Excision of the coccyx for the treatment of therapy-resistant coccygodynia is a disputable management option. Due to the low morbidity only few studies concerning the long-term follow-up after coccygectomy exist. The aim of this study is a retrospective analysis of our patients surgically managed for coccygodynia and a critical review of the results obtained in comparison to the literature. 12 patients with complete radiographic and clinical data were included in the study. The average age of patients at the time of surgery was 43.3 years (11 - 75 years). The average follow-up was 9.8 years (2 - 16 years). As suggested by Hambly (1989) the clinical result was assessed according to postoperative pain status and subjective patient satisfaction. 9 of 12 patients regarded the surgical intervention as a success and claimed that they would repeat the procedure (75 %). Three patients did not show marked improvement after coccygectomy. All patients (n = 6) surgically managed for traumatically induced coccygodynia had a positive result, while only 3/6 patients treated for idiopathic coccygodynia reported that symptoms were postoperatively reduced. According to our results and review of those documented in the literature, excision of the coccyx for the treatment of coccygodynia, after all conservative treatment options have been exhausted, seems a justifiable alternative. Patients with a history suggestive of traumatically induced coccygodynia are more likely to benefit from coccygectomy.
  • Article
    This article presents a retrospective review of the treatment of coccygodynia. The past 5 years of conservative treatment for coccygodynia were reviewed, including local injection. The results were evaluated. Retrospectively, the past 20 years of surgical treatment for coccygodynia were reviewed and the clinical results were evaluated. Twenty-four patients were treated with local injection and 15 patients were treated with coccygectomy. Local injection was successful in 78% of patients. Coccygectomy was successful in 87% of patients. The results of conservative treatment with local injection for coccygodynia appear to be successful. However, no other historical literature exists to compare these results. The results of coccygectomy for coccygodynia were also highly successful, and the success rate compares favorably to previous historical data in the literature.
  • Article
    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. Graphic abstract These slides can be retrieved under Electronic Supplementary Material. Open image in new window
  • Article
    To review the literature on coccydynia with specific reference to those cases of pregnancy and birth-related onset. Databases (Medline, CINAHL, MIDIRS) were searched using the keywords coccydynia, coccygodynia, coccyx, spine, pelvis, injury, and trauma. The references contained within this review are those which give clear information about clinical cases and are least anecdotal. Much of the literature is of poor quality when judged by current standards. Where there is no other literature older references remain of interest. There is little information about incidence, prevalence, pathophysiology, methods of differential diagnosis and efficacy of treatment for these women. No qualitative data from women with pregnancy or birth-related coccydynia were identified. Research into this topic needs to be undertaken if midwives are to be enabled to facilitate early diagnosis and provide care and advice for women with pregnancy and birth-related coccydynia.
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    Coccygectomy is a controversial operation. Some authors have reported good results, but others advise against the procedure. The criteria for selection are ill-defined. We describe a study to validate an objective criterion for patient selection, namely radiological instability of the coccyx as judged by intermittent subluxation or hypermobility seen on lateral dynamic radiographs when sitting. We enrolled prospectively 37 patients with chronic pain because of coccygeal instability unrelieved by conservative treatment who were not involved in litigation. The operation was performed by the same surgeon. Patients were followed up for a minimum of two years after coccygectomy, with independent assessment at two years. There were 23 excellent, 11 good and three poor results. The mean time to definitive improvement was four to eight months. Coccygectomy gave good results in this group of patients.
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    Several reports of coccygodynia have been confined to the causes, the methods of treatment, and the methods of radiological examination. As far as we know, there has been no previous study about the objective measurement of the coccyx. The purpose of this study was to find the possible cause of idiopathic coccygodynia by comparing the clinical and radiological differences between traumatic and idiopathic coccygodynia by innovative objective clinical and radiological measurements. Thirty-two patients with coccygodynia were evaluated retrospectively. We divided the patients into two groups. Group 1 consisted of 19 patients with traumatic coccygodynia and group 2 consisted of 13 patients with idiopathic coccygodynia. We reviewed medical records and checked age, sex distribution, symptoms, and treatment outcome in each group. We also reviewed coccyx AP and lateral views of plain radiological film and measured the number of coccyx segments and the intercoccygeal angle in each group. The intercoccygeal angle devised by the authors was defined as the angle between the first and last segment of the coccyx. We also checked the intercoccygeal angle in a normal control group, which consisted of 18 women and 2 men, to observe the reference value of the intercoccygeal angle. The outcome of treatment was assessed by a visual analogue scale based on the pain score. Statistical analysis was done with Mann-Whitney U test and Chi-square test. Group 1 consisted of 1 male and 18 female patients, while group 2 consisted of 2 male and 11 female patients. There were no statistically significant differences between the traumatic and idiopathic coccygodynia groups in terms of age (38.7 years versus 36.5 years), male/female sex ratio (1/18 versus 2/11), and the number of coccyx segments (2.9 versus 2.7). There were significant differences between the traumatic and idiopathic coccygodynia groups in terms of the pain score (pain on sitting: 82 versus 47, pain on defecation: 39 versus 87), the intercoccygeal angle (47.9 degree versus 72.2 degrees), and the satisfactory outcome of conservative treatment (47.4% versus 92.3%). The reference value of the intercoccygeal angle in the normal control group was 52.3 degrees, which was significantly different from that of the idiopathic group. In conclusion, the intercoccygeal angle of the idiopathic coccygodynia group was greater than that of the traumatic group and normal control group. Based on the results of this study, the increased intercoccygeal angle can be considered a possible cause of idiopathic coccygodynia. The intercoccygeal angle was a useful radiological measurement to evaluate the forward angulation deformity of the coccyx.
  • Article
    To evaluate the role of computed tomography (CT) in needle placement for ganglion impar blocks, and to determine the efficacy of CT-guided ganglion impar blocks in the management of coccydynia. The results of ganglion impar blockade in eight patients with coccydynia secondary to trauma or unknown cause were reviewed. The diagnosis of coccydynia was based on clinical history, location of pain, and response to previous diagnostic and therapeutic procedures. The eight patients were treated with CT-guided ganglion impar blocks to manage their coccyx pain after conservative procedures, including oral medication and cushions, failed to provide relief. All patients were subjected to ganglion impar blocks under a thin-section CT-guided technique for needle placement, using a mixture of bupivacaine and triamcinolone. The patients were followed-up for a period of 6-months. Eight patients were treated in this study with a total of 11 injections. A technical success of 100% was achieved in all cases with accurate needle placement without any complications and all the patients tolerated the procedure well. Out of eight, three patients (37%) had complete relief of pain on the follow-up intervals up to 6 months. Three out of eight patients (37%), had partial relief of symptoms and a second repeat injection was given at the 3 month interval of the follow-up period. At the end of the 6-month follow-up period, six out of eight patients (75%) experienced symptomatic relief (four complete relief and two partial relief) without any additional resort to conventional pain management. Twenty-five percent (two out of eight) did not have any symptomatic improvement. The mean visual analogue score (VAS) pre-procedure was 8 (range 6-10) and had decreased to 2 (range 0-5) in six out of eight patients. CT can be used as an imaging method to identify the ganglion and guide the needle in ganglion impar blockade. The advantages of CT-guided injection over those performed under fluoroscopy may include accurate and confident needle placement in the sacro-coccygeal region, ease of wide area coverage, lesser risk of complications due to inadvertent injections into the major pelvic structures, and increased likelihood of reaching the ganglion impar, especially in cases with anatomical variation in the ganglion impar location. These factors may have implications in the overall success rate of ganglion impar blockade.
  • Article
    Coccydynia is a painful disorder characterised by coccygeal pain which is typically exaggerated by pressure. It remains an unsolved mystery because of the perceived unpredictability of the origin of the pain, some psychological traits that may be associated with the disorder, the presence of diverse treatment options, and varied outcomes. A more detailed classification based on the aetiology and pathoanatomy of coccydynia helps to identify patients who may benefit from conservative and surgical management. This review focuses on the pathoanatomy, aetiology, clinical features, radiology, treatment and outcome of coccydynia.
  • Article
    Visceral pain transmitted by fibers of the sympathetic nervous system in the perineal and pelvic area, whether of benign or malignant etiology, can be effectively treated with neurolysis of the ganglion of Walther, also known as the ganglion impar or sacrococcygeus ganglion. Other possible indications for this technique are shooting anal pain and enteritis. This blockade can rarely eliminate somatic pain or neuropathic features. After this technique has been performed, the required dose of opioid and non-opioid analgesic agents is usually substantially reduced, leading to relief of adverse effects and maximizing analgesic action. The performance of this percutaneous technique can be considered to be of low complexity and with minimal side effects.We describe five cases of pelvic, perineal and coccygeal pain of different etiologies and poor response to conventional drug treatment, as well as the response and clinical course of these patients after completion of ganglion impar blockade with radiofrequency, local anesthetics and phenol neurolysis.
  • Article
    Despite its small size, the coccyx has several important functions. Along with being the insertion site for multiple muscles, ligaments, and tendons, it also serves as one leg of the tripod-along with the ischial tuberosities-that provides weight-bearing support to a person in the seated position. The incidence of coccydynia (pain in the region of the coccyx) has not been reported, but factors associated with increased risk of developing coccydynia include obesity and female gender. This article provides an overview of the anatomy, physiology, and treatment of coccydynia. Conservative treatment is successful in 90% of cases, and many cases resolve without medical treatment. Treatments for refractory cases include pelvic floor rehabilitation, manual manipulation and massage, transcutaneous electrical nerve stimulation, psychotherapy, steroid injections, nerve block, spinal cord stimulation, and surgical procedures. A multidisciplinary approach employing physical therapy, ergonomic adaptations, medications, injections, and, possibly, psychotherapy leads to the greatest chance of success in patients with refractory coccyx pain. Although new surgical techniques are emerging, more research is needed before their efficacy can be established.
  • Article
    Study Design. A total of 208 consecutive coccydynia patients were examined with the same clinical and radiologic protocol. Objectives. To study radiographic coccygeal lesions in the sitting position, to elucidate the influence of body mass index on the different lesions, and to establish the effect of coccygeal trauma. Summary of Background Data. A protocol comparing standing radiographs and radiographs subsequently taken in the painful sitting position in coccydynia patients and in controls has shown two culprit lesions: posterior luxation and hypermobility. Obesity and a history of trauma have been identified as risk factors for luxation. Methods. Dynamic radiographs were obtained. The body mass index was compared with the coccygeal angle of incidence, sagittal rotation of the pelvis when sitting down, and the presence and time of previous trauma. The patients with the newly described lesions were examined after an anesthetic block under fluoroscopic guidance. Results. Two new coccygeal lesions are described (anterior luxation and spicules). Obesity was found to be a risk factor. The body mass index determines the way a subject sits down, and lesion patterns were different in obese, normal-weight, and thin patients (posterior luxation: 51%, 15.2%, 3.7%; hypermobility: 26.5%, 30.3%, 14.8%; spicules: 2%, 15.9%, 29.6%; normal: 16.3%, 32.6%, 48.1%, respectively;P < 0.0001). Trauma affected the type of lesion only if it was recent (<1 month before the onset of coccydynia), in which case the instability rate increased from 55.6% to 77.1%. Backward-moving coccyges were at greatest risk of trauma. Conclusions. This protocol allows identification of the culprit lesion in 69.2% of cases. The body mass index determines the causative lesion, as does trauma sustained within the month preceding the onset of the pain.
  • Article
    Objetive: To test the efficacy and safety of the Walter ganglion blockade trough coccygeal disc, in patients who suffered from coccygodynia. Patients and Methods: We evaluated six patients, 4 women (66,6%) and two men (33,4%), with chronic coccyx pain (>6 months), and more than 6 points in Visual Analogue Scale (VAS). We described the trans-coccygeal disc approach to Walter ganglion blockade technique. The improvement of pain score, degree of satisfaction and complications of the patients were evaluated. Results: Five patients improved VAS score 6 to 1. All the patients were satisfied with the treatment. We had no complications. Conclusions: The trans-discal approach of the Walter ganglion is easy, safe (with less risk of rectal perforation and bone traumatism than the classical ano-coccygeal ligament via), and effective for chronic coccygodynia.
  • Article
    Although childbirth is a well-known cause of coccydynia, this condition has not been studied previously. To explore the characteristics of postpartum coccydynia and identify risk factors. A case series study. A specialist coccydynia clinic in a department of physical medicine in a university hospital. A series of 57 women suffering from postpartum coccydynia was analyzed and compared with a control group of 192 women suffering from coccydynia due to other causes. Dynamic radiography enabled a comparison of the coccygeal mobility in the two groups. 7.3% of the cases of coccydynia in female patients seen in our clinic were related to childbirth. The pain appeared as soon as the patient adopted the sitting position after delivery. The deliveries had often been performed with instruments (forceps deliveries: 50.8%; vacuum-assisted deliveries: 7.0%) or were spontaneous but described as "difficult" (12.3%). Luxation of the coccyx was observed in 43.9% of the cases and 17.0% of the controls. Fracture of the coccyx was involved in 5.3% of the cases. A body mass index >27 and ≥2 vaginal deliveries were associated with a higher prevalence of luxation of the coccyx. Postpartum coccydynia is often associated with a difficult delivery, with the use of forceps in 50.8% of cases. Luxation and fracture of the coccyx are the two most characteristic lesions. Clinical rehabilitation impact. Our results bring a better knowledge and should allow a better management of this specific etiology of coccydynia.
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