Polymethylmetacrylate Cement Augmentation of the Coccyx (Coccygeoplasty) for Fracture: A Case Report

Abstract

Background: Coccydynia is a painful condition of the sacrococcygeal region, with symptoms associated with sitting and rising from a seated position. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic. Percutaneous vertebroplasty and sacroplasty are the methods that are widely used for treating compression fractures and sacral insufficiency fractures, respectively. However, the success of polymethylmethacrylate injection in the treatment of osteoporotic coccyx fractures and coccydynia is still unknown. Case Report: A 68-year-old man was admitted to our clinic with complaints of pain in the sacrococcygeal and perianal regions. In the imaging studies, a fracture line in the fifth sacral and first coccygeal segments was observed as evidenced by a bony edema. Since the patient’s pain did not improve with conservative methods, we treated him with coccygeoplasty. No complication was encountered. The day after the operation, he was discharged from the hospital with complete pain relief. The patient confirmed having no pain on the third postoperative month and so did not need any analgesics. Conclusion: Coccyceoplasty may be a good treatment option for retractable pain in patients with acute or subacute osteoporotic coccygeal fractures and coccydinia with edema.

Coccygeoplasty: preliminary experience with this new alternative treatment of refractory coccydynia in patients with coccyx hypermobility

“…The surgical approach described herein differs from the previous case reports of coccygeoplasty, as it uses a single-needle technique introducing the PMMA through the midline into the sacrococcygeal axis 14 15. No problems were encountered using this midline needle placement approach in relation to the central spinal canal.…”

“…Coccygeoplasty (CP) consists of the percutaneous injection of polymethylmethacrylate (PMMA) cement into the sacrococcygeal segments. To our knowledge, only two case reports have been published about CP 14 15. Although it might be a relatively new treatment for coccydynia related to coccygeal hypermobility, injection of PMMA has been widely used in the treatment of pain for vertebral fractures 16 17…”

Coccydynia: A Narrative Review of Pathophysiology, Etiology and Treatment

“…Alone with local corticosteroids or local anesthetics, it can be applied both locally to the pericoccygeal area or directly to unstable coccygeal insertion or bone spur. 6,26,27 In cases with a response to the treatment, repeated injection can be performed at intervals. It has been reported that pain control can be achieved only by applying injection in 59% of the cases, and the success rate reaches to 85% in cases where injection and manipulation are combined.…”

“…Coccygeoplasty is an effective alternative in patients with acute-subacute osteoporotic coccygeal fracture in which we see hyperintensity in the STIR sequence on MRI revealing edema in the coccyx. 25,26 This method can be used safely with local anesthesia and has a low risk of complications, especially in patients with osteoporotic fractures. During the procedure, fluoroscopy imaging in antero-posterior and lateral planes should be performed.…”

“…For these reasons, it is recommended as an alternative method in patients with Coccydynia who have osteoporotic fractures and who do not respond to treatment. 25,26 Surgical Options Surgical procedures should be considered in a small number of cases who do not respond to all treatment methods. Surgery can be performed in patients who do not respond to conservative treatment for 3-6 months.…”