Coccygectomy: an effective treatment option for chronic coccydynia

Trollegaard, Anton Mitchell; Aarby, Nanett Skjellerup; Hellberg, Steen

doi:10.1302/0301-620x.92b2.23030

Cited by 69 publications

(51 citation statements)

References 24 publications

(35 reference statements)

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“…One way to prevent infection is to avoid rectal touch during surgery. (9). In our series, we did not spot the effects of etiology on the outcomes of treatment.…”

Section: Discussionmentioning

confidence: 92%

Treatment principles for coccygodynia

Dalbayrak¹,

Yaman²,

Yılmaz³

et al. 2014

Turkish Neurosurgery

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AIM: An evaluation of treatment methods and outcomes for coccygodynia cases that do not respond to conservative treatment. MATERIAL and METHODS:Local anesthetic and steroid injections were applied in 32 coccygodynia cases that did not respond to conservative treatment (average of 15 months). Coccyx excision was performed as surgical treatment in 25 cases that had pain relief after the injections but later re-presented with complaints. The patients' pain levels were assessed with VAS. Postacchini classification was used for patient classification based on plain radiography.RESULTS: 20 (62%) of the cases (the total including injection and surgery groups) had a trauma history. Majority of the cases treated with local steroid injection included patients with Type I, while the 25 cases that received surgical treatment predominantly included Type II patients. One case had post-operative skin infection, which was treated with antibiotics. It was observed by comparing pre-operative and post-operative pain scores that both methods provided significant pain relief in all patients. CONCLUSION:While local steroid injection is an effective method of treatment for Type I patients, the coccyx removal is an effective method for controlling the pain in patients with trauma history and in Type II, III and IV patients. yÖNTEM ve GEREÇLER: Konservatif tedaviye (ortalama süre: 15 ay) yanıt vermeyen 32 koksigodiniya olgusuna lokal anestezik ve steroid enjeksiyonu uygulandı. Enjeksiyon sonrası ağrıları geçen ancak bir süre sonra yakınmaları tekrar ortaya çıkan 25 olguya cerrahi olarak koksiks eksizyonu uygulandı. Hastaların ağrı düzeyleri VAS ile değerlendirildi. Hastalar direkt grafilerde Postachini sınıflamasına göre sınıflandırıldı. BULGULAR:Olguların 20'sinde (%62) (Enjeksiyon ve cerrahi grubu toplamı) travma hikayesi mevcuttu. Lokal steroid enjeksiyonu ile tedavi hastaların büyük kısmı Tip I iken cerrahi olarak tedavi edilen 25 olguda daha çok Tip II hastalar mevcuttu. Cerrahi sonrası cilt enfeksiyonu gelişen bir olguya uygulanan antibiyotik kullanımı ile tedavi sağlandı. Tedavi öncesi ve sonrası ağrı şiddeti karşılaştırıldığında tüm hastalarda, her iki yöntemle de anlamlı olarak ağrının azaldığı gözlendi. SONUÇ:Koksigodiniya tedavisinde Tip I hastalarda lokal steroid enjeksiyonu etkili bir yöntemken; travma hikayesi olan ve tip II, III, IV hastalarda koksiksin çıkarılması ağrıyı kontrol etmekte etkin bir yöntemdir.

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“…One way to prevent infection is to avoid rectal touch during surgery. (9). In our series, we did not spot the effects of etiology on the outcomes of treatment.…”

Section: Discussionmentioning

confidence: 92%

Treatment principles for coccygodynia

Dalbayrak¹,

Yaman²,

Yılmaz³

et al. 2014

Turkish Neurosurgery

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“…Although not statistically significant, a retroverted tip was seen more often in women; this may be related to previous childbirth but we had no data on parity to test this suggestion. Postpartum coccydynia is relatively uncommon [2,10,11,27] but vaginal delivery may be a contributing factor to the higher prevalence of coccydynia in women. As Maigne and colleagues [7,28] have shown, obesity is an additional risk factor for both idiopathic and traumatic coccydynia.…”

Section: Measurementmentioning

confidence: 99%

“…Less common causes of coccydynia may be due to local bone or soft tissue pathology [8][9][10]. However, one-third of cases are idiopathic [2,[9][10][11]. Some authors have suggested that individuals with a greater ventral angulation of the coccyx are more at risk of developing idiopathic coccydynia [3,12].…”

Section: Introductionmentioning

confidence: 99%

CT morphology and morphometry of the normal adult coccyx

et al. 2012

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Purpose Lack of data on the in vivo morphology and morphometry of the normal adult coccyx hampers understanding of radiological abnormalities in idiopathic coccydynia. The aim of this study was to investigate normal adult sacrococcygeal morphometry. Methods Retrospective analysis of 112 adult CT scans (mean age 63 ± 14.6 years, 50 males) evaluated the following: number of coccygeal segments; joint fusion; coccygeal spicules, subluxation, sacralization, and scoliosis; sacrococcygeal straight and curved lengths and curvature indices; sacrococcygeal and intercoccygeal angles; and lateral deviation of the coccyx tip. Results Four coccygeal segments were present in 76 % of scans. Sacrococcygeal fusion was present in 57 % and intercoccygeal fusion was increasingly common more caudally; there was no significant association with age or gender. A bony spicule was present in 23 %. Subluxation was rare. Nine of 12 coccyges with a retroverted tip were female. Mean coccygeal curved length was 4.4 ± 0.8 cm in men and 4.0 ± 0.8 cm in women (P \ 0.01). Mean angle between first and last coccygeal segments was 138°± 25°in men and 147°± 25°in women (P = 0.08). There was no significant correlation between coccygeal length or curvature and stature, age or BMI. Conclusions In this first detailed study of the CT morphology and morphometry of the adult coccyx, sacrococcygeal and intercoccygeal joint fusion was common. Female coccyges were shorter, straighter, and may be more prone to retroversion, factors that may be relevant to the markedly higher prevalence of idiopathic coccydynia in women.

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“…Conservative management is successful in approximately 90% of patients. 25,27,28 Ergonomic adaptation is commonly used. Methods include strapping of the buttocks, postural training and the use of a rubber ring or a firm corset, but there is little evidence to support their use.…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Various authors 2,13,19,20,28,40,42 have reported good to excellent results in patients who underwent coccygectomy for coccydynia (Table III). Careful patient selection appears to be the key to success.…”

Section: Functional Outcomesmentioning

confidence: 99%

Coccydynia

Nathan

Fisher

Roberts

2010

The Journal of Bone and Joint Surgery. British volume

116

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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.Pain in the region of the coccyx is referred to as coccydynia or coccygodynia. A convoluted literature exists on its aetiology and management. 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 the 16th and 17th centuries.

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Coccygectomy: an effective treatment option for chronic coccydynia

Cited by 69 publications

References 24 publications

Treatment principles for coccygodynia

Treatment principles for coccygodynia

CT morphology and morphometry of the normal adult coccyx

Coccydynia

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