Transsacrococcygeal approach to ganglion impar block for treatment of chronic coccygodynia after spinal arachnoid cyst removal

Abstract

Background:Coccygodynia is a pain in the region of the coccyx that radiates to the sacral, perineal area. The cause of the pain is often unknown. Coccygodynia is diagnosed through the patient's past history, a physical examination, and dynamic radiographic study, but the injection of local anesthetics or a diagnostic nerve blockade are needed to distinguish between somatic, neuropathic, and combined pain. Ganglion impar is a single retroperitoneal structure made of both paravertebral sympathetic ganglions. Although there are no standard guidelines for the treatment of coccygodynia, ganglion impar blockade is one of the effective options for treatment.Methods:Here, we report a 42-year-old female patient presenting with severe pain in the coccygeal area after spinal arachnoid cyst removal.Results:Treatment involved neurolysis with absolute alcohol on the ganglion impar through the transsacrococcygeal junction. Pain was relieved without any complications.Conclusion:Our case report offers the ganglion impar blockade using the transsacrococcygeal approach with absolute alcohol can improve intractable coccydynia.

Chronic Pelvic Pain; a tragic miss

“…During vaginal delivery, the incidence of a sacrococcygeal ligament injury is very high and is one of the reasons for the coccygeal pain. 3 Coccyx is a delicate and mobile bone which is supported by the sacrococcygeal ligament and has more chances of sprain.…”

“…Conservative management of coccydynia includes simple analgesics and use of donut shaped coccyx support for sitting on to prevent irritation of or pressure on the sacrococcygeal ligament. 3 If the pain persists or does not respond to oral analgesics then interventional procedure known as ganglion impar block is performed. However, advanced techniques include chemical neurolysis and radiofrequency ablation of the ganglion impar.…”

A Medically Challenging Case of Ganglion Impar Neurolysis in a Patient with Significant Medical Comorbidities, Coccydynia, and Severe Disability

“…It is reported in the literature the use of radiofrequency thermocoagulation of the ganglion impar for the treatment of chronic coccydynia with success in patients unresponsive to conservative treatment (16). And there is only one other case study that reported the use of alcohol neurolysis of the ganglion impar for the treatment of chronic coccydynia after spinal arachnoid cyst removal (17). conclusion This is a very unique case of chemical neurolysis of the ganglion impar in a patient failing multiple therapies.…”

Intractable anal pain in B-cell acute lymphocytic leukemia patients: treatment options

“…Blocking it is useful in patients who suffer from pain in the pelvic and perineal structures as it provides nociceptive and sympathetic supply to this region [5]. The ganglion impar block is a well established procedure for the treatment of coccydynia [6], but its role in the treatment of anal pain with varied aetiologies is not well studied. In our case, the ganglion impar block hit the pain pathway's bullseye, and we were able to relieve the patient's unbearable discomfort.…”