Abstract
BACKGROUNDCoccydynia refers to debilitating pain in the coccygeal region of the spine. Treatment strategies range from conservative measures (e.g., ergonomic adaptations, physical therapy, nerve block injections) to partial or complete removal of the coccyx (coccygectomy). Because the surgical intervention is situated in a high-pressure location close to the anus, a possible complication is the formation of sacral pressure ulcers and infection at the incision site.OBSERVATIONSIn this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia.LESSONSAlthough this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy.
Highlights
Coccydynia refers to debilitating pain in the coccygeal region of the spine
Coccygeal morphology: Based on its curvature, the anatomy of the sacrococcygeal junction was categorized into four different configurations by Postacchini and Massobrio in 1983,4 with two more types further added by Nathan et al.[3]: type I, minor anterior curvature; type II, noticeable anterior curvature with the apex pointing straight forward; type III, sharp angulation at the superior intercoccygeal joints; type IV, subluxation between segments; type V, retroverted appearance with posteriorly angulated apex; and type VI, scoliotic or laterally subluxated coccyx
Endoscopic Coccygectomy: Surgical Technique A video describing the technique can be found as part of the Supplementary Material (Video 1)
Summary
Coccydynia refers to debilitating pain in the coccygeal region of the spine. OBSERVATIONS In this case report, the authors presented a minimally invasive, fully endoscopic approach to safely perform complete coccygectomy for treatment of refractory posttraumatic coccydynia. LESSONS this is a single case report, the authors hope that this novel endoscopic approach may achieve improved wound healing, reduced infection rates, and lower risk of penetration injury to retroperitoneal organs in patients requiring coccygectomy. Coccydynia refers to debilitating pain in the coccyx region of the spine. The term was first adopted by Simpson in 1859, and it is derived from two Greek words: coccyx (resemblance to a cuckoo’s beak) and dynia (pain).[1] At least six different etiologies have been identified as potential causes/risk factors to develop coccydynia: 1. Depending on the severity of the trauma, the injury may include a sprain of the pelvic floor muscles, mild distortion over a fissure in the caudal coccygeal segment, or a severe fracture-dislocation of the sacrococcygeal complex
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