Treatment principles for coccygodynia

Abstract

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.

Short-term efficacy of joint and soft tissue injections for musculoskeletal pain: An interventional cohort study

“…[27,29] We administered injections into the coccygeal region with rectal manipulation in cases resistant to conservative treatment and observed consistent reductions in pain scores, similar to the findings of previous studies. A study by Dalbayrak et al [27] provides evidence that local CS injection is an effective method of treatment for patients with coccygodynia characterized by forward curvature and an absence of angulation. A 5-year prospective trial performed by Wray et al [30] concluded that physiotherapy treatment was of little help, but 59% of patients responded to local injections of CS and LA.…”

“…Principal methods of pain reduction include analgesic use, limitation of sitting, use of ring-shaped pillows, and physiotherapy. [27,28] In resistant cases that fail to respond to conservative treatment, intrarectal manipulation of the lower coccygeal segment can be used, occasionally with massage of the coccygeal muscles, and LA with CS injections. [27,29] We administered injections into the coccygeal region with rectal manipulation in cases resistant to conservative treatment and observed consistent reductions in pain scores, similar to the findings of previous studies.…”

“…[27,28] In resistant cases that fail to respond to conservative treatment, intrarectal manipulation of the lower coccygeal segment can be used, occasionally with massage of the coccygeal muscles, and LA with CS injections. [27,29] We administered injections into the coccygeal region with rectal manipulation in cases resistant to conservative treatment and observed consistent reductions in pain scores, similar to the findings of previous studies. A study by Dalbayrak et al [27] provides evidence that local CS injection is an effective method of treatment for patients with coccygodynia characterized by forward curvature and an absence of angulation.…”

Pelvic incidence as a prognostic factor in coccydynia

“…Coccydynia is not a frequent symptom, and most patients who suffer direct trauma to the coccygeal region do not suffer from the condition. Other reasons for coccydynia show a wide variety ranging from minor repetitive trauma to coccygeal tumors (3)(4)(5)8,25). Conservative treatment, which consisting of NSAIDs and sitting modifications, is usually effective and should be the first step of treatment (7,20).…”

“…Local injections could be a second step of treatment when the conservative treatment fails (1,7,16). When patients do not respond to non-surgical measures, coccygectomy is usually indicated to relieve pain (3)(4)(5)8,25). There is no predictive factor that determines the most efficient treatment method for a patient.…”