Novel approach for pericapsular radiofrequency ablation of sacrococcygeal junction for patients with coccydynia

Abstract

IntroductionCoccydynia is a multifactorial complex clinical challenge. A multimodal approach with both conservative measures and procedural interventions is often recommended. We described a novel approach of radiofrequency (RF) ablation for the management of coccydynia.MethodsThree patients with known history of coccydynia refractory to conservative therapy were referred to our clinic. All received different types of RF ablation before: one with anterior bipolar lesion with no analgesia benefit, one with posterior stripped lesion with good benefit but only after 8 weeks of pain flare and one received anterior monopolar lesion with 50% pain reduction for 2–3 months. All subjects underwent a novel RF ablation to the anterior surface of the sacrococcygeal and intercoccygeal joints with two bipolar lesions using multi-tined needles under fluoroscopy guidance. One bipolar lesion was between two needles: one in the sacrococcygeal and another in the intercoccygeal (between first and second coccyx) joints. Another bipolar lesion was between needles on both side of the sacrococcygeal joint.ResultsAll experienced at least 65% pain relief for 6 months. The sitting endurance increased from less than 5 min to an average of 70 min. No adverse effect was observed in two and in the patient who used to have pain flare after lesioning, the pain flare lasted only for 2 weeks.DiscussionThe configuration of the two bipolar lesions with multi-tined needles in this case series stimulates the thinking of new approach for the ablation technique for pain from coccyx. Further prospective large case cohort study is needed.

Response to Dr C Liu

“…We would like to thank Dr Liu for their interest in our article 1 2. I agree with them that any practitioner performing the radiofrequency ablation (RFA) procedure to the presacral space should be cognizant of the rectum injury and avoid this complication at all costs.…”

Novel approach to pericapsular radiofrequency ablation of sacrococcygeal junction for patients with coccydynia

“…We would like to congratulate Feigin et al on their recent publication, ‘Novel approach to pericapsular radiofrequency ablation of sacrococcygeal junction for patients with coccydynia’ 1. In this publication, they described a technique whereby one multitined needle was inserted through the coccygeal 1 and 2 junction and another needle was inserted through the sacrococcygeal ligament.…”

Ganglion impar block a matter of safety and efficacy

“…Recent evidence suggests that innervation of the tailbone may be more complex. New approaches regarding coccydynia are trying to block not only the ganglion impar, but other structures of the coccygeal plexus and coccygeal nerves arising from the dorsal rami innervating the posterior coccyx 4 5. Therefore, we suggest analyzing pain pathways (anterior, posterior, somatic, visceral or both components).…”