Coccygeal Pain Research Articles

A Singal Case Studyon Coccygodynia

Pain in the coccyx region is known as coccydynia or coccygodynia. Coccygeal pain has been documented since the 16th century, according to Simpson, coccygeal pain has been recognised for hundreds of years, treating it can be challenging and occasionally contentious due to the complex nature of coccygeal pain. Its genesis is influenced by numerous physiological and psychological factors. With or without conservative treatment, most occurrences of coccydynia recover within weeks to months, but in a small number of people, the pain can last a long time and be incapacitating. Female gender and obesity have been linked to an increased chance of acquiring the condition. The anatomy, physiology, diagnosis and therapy of coccydynia are briefly discussed in this Study. For individuals with intractable coccyx discomfort, a multidisciplinary strategy including physical therapy, ergonomic modifications, drugs, injections, and potentially psychotherapy has the best chance of recovery. A 26 years old Female patient came in OPD with Symptoms of Pain and tenderness in coccyx region, aggravated with sitting position. In past history a patient is fall down from vehicle in direct vertical position, at this incidous mild discomfort in lower back region, after that gradually increase pain in coccyx region within two days. Patient could not able to seat proper and pain remain constant. So, she came to Govt. Akhandanand Hospital for ayurvedic treatment.The patient was treated with ayurvedic medicines Yogaraj Guggulu, Dashmoolkwath, Tab.bocomo and advise to take sitz bath with luke warm water and use wedge shape cushion on sitting position. The patient was advised to follow up initially after 7 days and later after every 15thdays. After 7 days there were mild pain and no tenderness. After that pain gradually decrease. The pain was completely gone on the third follow up and no any other complaints related to coccydynia.

Coccygodynia: Address of Osteopathy & Manual Medicine

Coccygodynia is characterized by pain located in the Coccyx and the sacrococcygeal joint. In general, coccygodynies have the reputation of being rebellious to pharmacological treatments: analgesic and infiltrations just give irregular success on the one hand, and surgery: a sometimes-heavy treatment for a modest lesion on the other hand. Manual medicine and osteopathy in coccygodynia occurring after a fall, bariatric surgery or after childbirth are almost all immediately cured by the maneuver we propose in this article. Osteopathic manual medicine is truly a first-line method of therapeutic choice regarding editorials and our own clinical experiences. The osteopath will determine what are the structures involved in coccygeal pain, investigate the different anatomical causes. He will thus be responsible for removing all joint, ligament and muscular blockages of the pelvis, both locally and remotely, which is not generally possible with pharmacological therapies.

Neuromodulation Techniques in Chronic Refractory Coccydynia: A Narrative Review.

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.

IS A COCCYGECTOMY AN EFFICACIOUS SURGICAL TREATMENT FOR DEBILITATING COCCYGEAL PAIN?

To determine the demographic, pre-operative, operative, post-operative, and outcome in seven patients who presented to our unit over a 5-year period and underwent a coccydectomy for coccydynia unresponsive to conservative measures.We performed a retrospective chart review of seven patients who presented to the Department of Orthopaedics at Helen Joseph hospital, University of the Witwatersrand, Johannesburg, South Africa, with coccidia unresponsive to a trial of adequate conservative measures, and underwent operative intervention. The study period was from 01 January 2014 to 31 December 2018.The mean age of subjects in our study was 53 years. The average length of conservative treatment prior to presentation to our unit was 8 months. All patients were taken to surgery and the mean length of surgery was 49 min and the mean volume of intra-operative blood loss was 63.4 ml. In all 7 (100%) of subjects a total coccygectomy was performed. At our 1-year end point all 7 (100%) subjects reported a favourable outcome and were satisfied – extremely satisfied with the procedure.In our study a total coccygectomy resulted in a significant reduction in coccygeal pain and subjects a 1-year follow-up end point. We recommend that in patients who fail an adequate recognized trial of conservative measures for coccydynia, a total coccygectomy should be performed.

The Impact of Coccydynia with Radiological Modality: A Systemic Review

Coccydynia, or Coccygodynia, is pain in the region of the Coccyx. Despite the identification of chronic coccygeal pain hundreds of yearsago, its treatment can be difficult and sometimes controversial because of the multifactorial nature of coccygeal pain.[1] Many Physiologic and psychological factors contribute to its etiology. Most cases of coccydynia resolve within weeks to months with or without conservative treatment, but for a few patients the pain can become chronic and debilitating.[2] Coccydynia is pain located in the coccygeal bone or the surrounding tissues. Coccydynia is a relatively rare condition, occurring more frequently in females and in all ages. Coccydynia is most frequently associated with single axis traumatic injury, childbirth, obesity, and rapid weight-loss related to gastric bypass surgery. There are several etiologies to the occurrence of secondary coccydynia, such as cancer pain, infection.[3]

Coccydynia: anatomic origin and considerations regarding the effectiveness of injections for pain management.

Coccydynia is a debilitating pain disorder. However, its pathophysiology is not well understood. When approaching coccydynia, the exact underlying cause of pain must be identified to develop an appropriate treatment plan. The specific approach to coccydynia can vary depending on an individual's condition and the underlying cause. Thorough evaluation by a pain physician is essential to determine the most appropriate course of treatment. The purpose of this review is to examine the various causes contributing to coccygeal pain and specifically focus on the exact anatomical neurostructures, such as the anococcygeal nerve, perforating cutaneous nerve, and ganglion impar. We also reviewed the relevant clinical outcomes and suggested recommendations for each anatomical structure.

Ganglion Impar Block For Chronic Coccydynia.

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. 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. 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). Ganglion Impar neurolysis is highly effective in the treatment of chronic coccydynia.

LOCAL STEROID INJECTION IN THE TREATMENT OF REFRACTORY COCCYDYNIA

Coccydynia or coccygeal pain is a medical condition although rare which manifests as pain and tenderness over the coocygeal region. These patients have mostly difculty sitting and the symptoms are excarbratted by pressure. The condition typically responds to conservative management like Non steroidal antinammatory drugs(NSAIDS) , sitz baths, soft cushions, rectal manipulation Our study included 30 patients with coccygeal pain refractory to other means of treatment. We used 40 ml triamcinolone along with 2ml of 1% lidocaine introduced locally. The outcome was studied by ability of the patient to sit, by eliciting the local tenderness and the VAS score. We concluded that injecting steroid injection in patients with refractory coccydynia is a good alternative option with minimal complications.

Platelet-rich Plasma for Refractory Coccydynia: A Case Report

Introduction: Coccydynia is a common syndrome characterized by pain localized to the tailbone that radiates into the lower sacrum and perinium. Coccydynia affects female patients more frequently than male patients. It occurs more commonly after direct trauma from fall directly onto the coccyx. The pain is caused commonly by the strain of sacrococcygeal ligament or fracture of the coccyx and less commonly secondary to arthritis. Conservative treatment of coccydynia include simple analgesics and foam donut to prevent irritation to sacrococcygeal ligament. If pain persist, usually ganglion impar block and radiofrequency are alterative options. There are no strong evidence to support coccygectomy.&#x0D; Case Report: A 40-year-old presented with coccygeal pain for more than six months. The patient was seen at the pain clinic in Prince Sultan Military Medical City after failure of conservative and multiple steroid injections followed by radiofrequency therapy. We discussed with the patient a trial of a platelet-rich plasma (PRP) injection into the sacrococcygeal ligament under fluoroscopic guidance with full details endorsed to the patient including the risks and benefits of the procedures and informed consent signed before the injection. Pain severity score was taken before and about one month after each injection. The patient received a total of three PRP injections.&#x0D; Result: The patient reported about 30%, 70%, and 85% pain reduction after the first, second, and third injection, respectively. At six months, the patient continued to experience the same level of reduced pain without the use of regular pain medications.&#x0D; Conclusion: PRP can be considered as an option for the treatment of patients with refractory coccydynia.

Spinal Cord Stimulation of the Sacral Region as a Treatment for Intractable Coccygodynia: A Case Study

BACKGROUND: Coccygodynia is a notoriously difficult condition to manage. Spinal cord stimulation (SCS) may be a promising therapeutic option for those suffering from chronic coccygeal pain. To our knowledge, there are limited reports of using SCS to target the sacral region for the treatment of intractable coccygodynia. CASE REPORT: A 50-year-old woman with refractory coccygodynia underwent permanent implantation of an SCS device following a successful SCS trial. SCS leads were inserted using a retrograde approach to target S2-S4 bilaterally. During follow-up, the patient reported &gt; 90% improvement of coccygeal pain and her selfreported quality of life dramatically improved. CONCLUSION: This case report describes the successful use of the sacral region as a target for SCS in the management of intractable coccygodynia. SCS may be considered an effective treatment option when all other conventional methods have failed. KEY WORDS: Coccygodynia, neuromodulation, sacral nerve stimulation, spinal cord stimulation

Is a coccydectomy an efficacious surgical treatment for debilitating coccygeal pain?

IntroductionTo determine the demographic, pre-operative, operative, post-operative, and outcome in seven patients who presented to our unit over a 5-year period and underwent a coccydectomy for coccydynia unresponsive to conservative measures. Materials and methodsWe performed a retrospective chart review of seven patients who presented to the Department of Orthopedics at Helen Joseph hospital, University of the Witwatersrand, Johannesburg, South Africa, with coccidia unresponsive to a trial of adequate conservative measures, and underwent operative intervention. The study period was from 01 January 2014 to 31 December 2018. ResultsThe mean age of subjects in our study was 53 years. The average length of conservative treatment prior to presentation to our unit was 8 months. All patients were taken to surgery and the mean length of surgery was 49 min and the mean volume of intra-operative blood loss was 63.4 ml. In all 7 (100%) of subjects a total coccygectomy was performed. At our 1-year end point all 7 (100%) subjects reported a favourable outcome and were satisfied – extremely satisfied with the procedure. ConclusionIn our study a total coccygectomy resulted in a significant reduction in coccygeal pain and subjects a 1-year follow-up end point. We recommend that in patients who fail an adequate recognized trial of conservative measures for coccydynia, a total coccygectomy should be performed.

Coccygeal excision for treatment of coccyx instability

Introduction: Coccygeal excision or coccygectomy is a rare procedure for the treatment of coccygodynia. Coccygeal pain or coccygodynia, often successfully treated with conservative treatment, including steroid injection. In coccyx instability with persistent pain after failed with conservative and injection treatment, surgery is needed to remove the unstable tail bone segment. Methods: We present one case of persistent coccygeal pain in a twenty-five year old male. The patient had a history of trauma on the buttock 12 years ago, which is getting worse for the last one-year period. The patient has already undergone conservative treatment, including two episodes of steroid injection, but the pain still persists. From the lateral plain X-ray, it was found displacement on coccyx segment. Failed in conservative treatment leads to coccygeal excision. The surgical procedure was done in prone knee-chest position, and intraoperatively assessed the tailbone stability with image intensifier. Partial coccygectomy was done to this patient. Results: One month follow up showed painless tailbone, no surgical site infection, and no other complications. Conclusion: We conclude that coccygeal excision is a good treatment of choice for coccygodynia due to coccyx instability.

Precoccygeal Epidermoid Cyst: A rare Cause of Low Back Pain

A rare pathological entity of retro-rectal space is the formation of tumors (mass lesions), which arise from the surrounding tissues. Usually, the retro-rectal tumor formations appear to be asymptomatic for a long period of time. When a patient is symptomatic, s/he most commonly complains about sacral and coccygeal pain (coccygodynia). In our study, we reported a case of patient with precoccygeal epidermoid cyst who was presented with typical low back pain. In conclusion we can state that precoccygeal epidermoid cyst is an extremely rare pathological condition, which although can be the cause of LBP. So, it must be included in the group of the rare causes of LBP and each physician must always be suspicious of such a case, following the diagnostic algorithm.

Coccygectomy for patients with chronic coccydynia: a prospective, observational study of 98 patients.

The purpose of this prospective study was to evaluate the outcomes of coccygectomy for patients with chronic coccydynia. Between 2007 and 2011, 98 patients underwent coccygectomy for chronic coccydynia. The patients were aged > 18 years, had coccygeal pain, local tenderness and a radiological abnormality, and had failed conservative management. Outcome measures were the Short Form 36 (SF-36), the Oswestry Disability Index (ODI) and a visual analogue scale (VAS) for pain. Secondary analysis compared the pre-operative features and the outcomes of patients with successful and failed treatment, two years post-operatively. The threshold for success was based on a minimum clinically important difference (MCID) on the ODI of 20 points. All other patients, including those lost to follow-up, were classified as failures. There was significant improvement in all ten components of the SF-36 (p < 0.05), the ODI (23 points) and VAS (39 points) (p < 0.0001). A total of 69 patients (70.4%) met the designated MCID threshold for a successful outcome. The failure group consisted of 25 patients (25.5%) who did not reach the MCID and four (4.1%) who were lost to follow-up. Six patients (6.1%) in the failure group had ODI scores that were no better or worse than that pre-operatively. The patients in whom treatment failed had significantly worse pre-operative scores for the ODI (p = 0.04), VAS (p = 0.02) and on five of ten SF-36 components (p < 0.04). They also had a higher incidence of psychiatric disorders, pre-operative opiate use and more than three comorbidities. Coccygectomy for chronic coccydynia results in significant improvement in patient-reported outcomes at two years. Failure is associated with certain pre-operative characteristics such as psychiatric illness, poor quality of life features, higher levels of pain, and use of opiates.

MRI in Coccydynia

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.

A rare cause of recalcitrant coccydynia: benign dermoid cyst masquerading as coccygeal pain

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. A 20-year-old male presented with typical symptoms of coccydynia recalcitrant to conservative treatment for 2years. Since pain interfered with his daily activities, magnetic resonance imaging was performed which showed a circumscribed precoccygeal cystic lesion. 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. 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.

Sacral roots stimulation in chronic pelvic pain

IntroductionChronic pelvic pain is a syndrome of chronic non-malignant pain of multifactorial pathophysiology. Perineal, anal and coccygeal pain can be a form of failed-back surgery syndrome or complex regional pain syndrome. Apart from conservative treatment interventional methods are useful in this condition as neurolytic blocks or non-destructive neuromodulation procedures. Peripheral nerve, spinal cord stimulation or sacral stimulation can be applied. AimWe describe a minimally invasive method of sacral roots stimulation with percutaneous electrodes implanted through the sacral hiatus in the treatment of chronic pelvic pain. Materials and methodsWe evaluated a series of nine female patients with pelvic pain treated with sacral roots stimulation in regard of efficacy and complications of this method. ResultsShort-term results in all patients were satisfactory with statistically significant improvement (median VAS=9 before surgery) (median VAS=2 after implantation, p=0.001), (median VAS=3 after 6 months, p=0.043). The long-term follow-up revealed less satisfactory result (median VAS=6 after 12 months). High incidence of complications was noted: mainly infection in 3/9 patients. ConclusionSacral roots stimulation is a non-destructive and minimally invasive neuromodulation method in the treatment of chronic pelvic pain. It can be effective even in the long-term observation but special care is advised to secure aseptic conditions in the implantation and to prevent the infection which leads to removal of the stimulating system.

An Assessment on the Ultrasound Guided Dextrose Prolotherapy for Persistent Coccygeal Pain: A Case Series and Review of Literature

An Assessment on the Ultrasound Guided Dextrose Prolotherapy for Persistent Coccygeal Pain: A Case Series and Review of Literature

The anatomy of the sacrococcygeal cornual region and its clinical relevance

There has been no systematic study of the anatomy of the region between the sacral and coccygeal cornua. Reference texts describe an intercornual ligament connecting these structures. The aim of this study was to investigate the anatomy of this region, which may be relevant to unexplained cases of coccygeal pain (coccydynia) and local nerve blocks. The bony anatomy of the sacrococcygeal (SC) cornual region was analyzed in 33 CT scans obtained from supine adults of mostly European origin with no known SC pathology, 7 μCT scans of cadaver SC specimens, and 105 Asian Indian adult skeletons. A further five cadaver SC specimens were examined histologically. SC cornual fusion was seen in 45% of CT/μCT scans (mean age 67 years, 20 males) and in 20% of adult skeletons (78 males); there was no association with age or sex. In the absence of SC fusion, the mean intersacrococcygeal cornual gap was 7.1 ± 2.4 mm; this was bridged by an intercornual ligament composed of parallel vertical collagen fibers reinforced by elastin fibers on its anterior surface. Small nerve branches were observed adjacent to the ventral aspect of the intercornual ligament and, in one case, traversing the ligament. Ipsilateral sacral and coccygeal cornua are therefore normally bridged by an intercornual ligament that is probably innervated. The cornua are fused on one or both sides in 20-45% of adults. These findings may have implications for some cases of coccydynia and for anesthetists performing local nerve blocks.

Accessing the challenging pre-sacral abscess

Dear Editor: Drainage of pre-sacral collections transrectally or percutaneously can be challenging due to difficulty of access. Transanal endoscopic surgery is a well-established technique used to resect benign or early malignant rectal tumours, either using a binocular stereoscopic operating rectoscope or a monocular laparoscopic equivalent, and a number of additional indications have been described for their use, including pelvic anastomotic stricturoplasty, excision of extraluminal pre-sacral tumours as well as drainage of pre-sacral abscesses which may otherwise be inaccessible. Transanal endoscopic microsurgery uses the stereoscopic equipment (Richard Wolf Medical Instruments Corporation), while the alternative produced by Storz is less expensive and fully compatible with standard laparoscopic equipment, and is referred to as transanal endoscopic operation (TEO). Patients can expect minimal effect on anorectal function despite the use of a large diameter rectoscope. TEO equipment was used to successfully drain an inaccessible pre-sacral abscess in a 53-year-old man with a bodymass index of 28. He had undergone reversal of a Hartmann's procedure which had been performed 7 months earlier for complicated diverticular disease with a pelvic abscess, and a tight anastomotic stricture at 10 cm from the anal verge was subsequently diagnosed another 7 months later after he complained of pelvic discomfort and obstructive symptoms. Imaging ruled out recurrent pelvic sepsis and he underwent three anastomotic balloon dilatations over a 12-month period, resulting in a widely patent anastomosis and a significant improvement in symptoms. Two years after the last dilatation, he developed new symptoms of coccygeal pain on prolonged sitting, which worsened over 5 months, and he subsequently developed additional symptoms of night sweats. A magnetic resonance imaging (MRI) scan confirmed a 4-cm pre-sacral abscess postero-superior to the anastomosis which remained widely patent. Long-term antibiotics did not improve his symptoms and little change in size was evident on repeat imaging, and transanal drainage was attempted under general anaesthesia. This was unsuccessful due to access difficulties related to the distance of the abscess from the anal canal and the patient's body habitus. The procedure was abandoned when no pus was able to be aspirated and a submucosal haematoma obscured the operative view. Symptoms persisted over 18 months despite repeated courses of antibiotics, until drainage was successfully achieved using TEO equipment. With the patient in lithotomy position, the 4.0-cm diameter, 7.5-cm long operating rectoscope facilitated access, providing a magnified view of the extraperitoneal anastomosis which was incised posteriorly using an ultrasonic dissector, deroofing a pre-sacral cavity which contained pus and was lined with granulation tissue. He was discharged on oral antibiotics 1 day after surgery and was reviewed in an outpatient setting 1month later. He described post-operative symptoms of faecal urgency and increased frequency, associated with ongoing night sweats and discharge of pus per rectum with minor bleeding, but all of these symptoms had fully resolved on further review 4 months later. The coccygeal pain also resolved post-operatively, and no incontinence was experienced. An MRI scan performed 5 months after surgery confirmed resolution of the chronic collection which measured 39 mm on imaging prior to the procedure. This case illustrates chronic sepsis with a delayed presentation after anastomotic balloon dilatation and highlights the ease of access achievable using laparoscopic equipment via an operating rectoscope to manage pelvic pathology which would otherwise be inaccessible using alternative modalities.