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Daily D, Bridges J, Mo WB, Mo AZ, Massey PA, Zhang AS. Coccydynia: A Review of Anatomy, Causes, Diagnosis, and Treatment. JBJS Rev 2024; 12:01874474-202405000-00004. [PMID: 38709859 DOI: 10.2106/jbjs.rvw.24.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
» Coccydynia is a painful condition affecting many patients at the terminal caudal end of the spine.» An understanding of coccyx anatomy and variations of morphology is necessary for proper diagnosis. A multifactorial etiology for pain may be responsible for this clinical entity.» Several treatment options exist. Successful outcomes for patients depend on individual patient characteristics and the etiology of pain.
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Affiliation(s)
- Drayton Daily
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - James Bridges
- School of Medicine, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - William B Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Andrew Z Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Patrick Allan Massey
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - Andrew S Zhang
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
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Manfre L, Gil I, Baptista T, Calvão Pires P, de Vivo AE, Masala S, Chandra RV, D'Anna G, Hirsch JA. Coccygeoplasty: preliminary experience with this new alternative treatment of refractory coccydynia in patients with coccyx hypermobility. J Neurointerv Surg 2022; 15:82-85. [PMID: 35882554 DOI: 10.1136/neurintsurg-2021-018149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/09/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Coccydynia has many causes, including fracture, subluxation, and hypermobility of sacrococcygeal segments. Existing treatments are limited in their effectiveness. Coccygeoplasty (CP) is a relatively new, minimally invasive treatment that appears to address this difficult clinical challenge. OBJECTIVE To describe clinical results at the time of the procedure and at 3- and 12-months' follow-up of patients with coccydynia related to subluxation and coccyx hypermobility treated with the CP technique. Additionally, to determine if there is any correlation between the final imaging and clinical results at 3- and 12-months' follow-up. METHODS A prospectively maintained database was used, and all patients who underwent CP for chronic coccydynia between January 2005 and October 2018 were retrospectively reviewed. All the patients had painful hypermobility (greater than 25°) with anterior flexion confirmed on radiological imaging. Alternative causes of coccydynia were excluded using CT and MRI. Procedures were performed under local anesthesia with combined fluoroscopic and CT guidance. Clinical follow-up was performed at two time points: 3 and 12 months after treatment using the Visual Analogue Scale (VAS). RESULTS Twelve patients were treated in a single center. No procedural complications occurred. At 3- and 12-months' follow-up, the majority (75%) of patients had significantly lower VAS scores than at baseline, with mean changes of 3.5 and 4.9, respectively. There was no pain recurrence at 12 months and just one patient had no improvement of the pain. Follow-up CT images confirmed fixation of the sacrococcygeal bone segments in nine patients; however, no correlation was found between final imaging results and clinical outcome (p=0.1). CONCLUSIONS Patients with refractory painful coccyx subluxation and hypermobility undergoing CP have a favorable clinical response at 3- and 12-months' follow-up. Further studies are required to validate this technique and to identify predictors of treatment response. Coccygeoplasty may be considered a reasonable alternative to coccygectomy.
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Affiliation(s)
- Luigi Manfre
- Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy
| | - Inês Gil
- Department of Neuroradiology, Centro Hospitalar do Algarve EPE, Faro, Portugal
| | - Tiago Baptista
- Department of Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK.,Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
| | - Pedro Calvão Pires
- Department of Neuroradiology, Centro Hospitalar de Lisboa Ocidental EPE, Lisboa, Portugal
| | - Aldo Eros de Vivo
- Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Italy
| | - Salvador Masala
- Department of Diagnosis Imaging Interventional Radiology and Clinical Pathology, Ospedale San Giovanni Battista, Roma, Italy
| | - Ronil V Chandra
- Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia.,Department of Image, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
| | - Gennaro D'Anna
- Department of Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
| | - Joshua A Hirsch
- NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
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Akar E, Koban O, Öğrenci A, Yılmaz M, Dalbayrak S. Polymethylmetacrylate Cement Augmentation of the Coccyx (Coccygeoplasty) for Fracture: A Case Report. Balkan Med J 2020; 37:348-350. [PMID: 32573177 PMCID: PMC7590546 DOI: 10.4274/balkanmedj.galenos.2020.2020.4.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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.
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Affiliation(s)
- Ezgi Akar
- Clinic of Neurosurgery, Haydarpaşa Numune Training and Research Hospital, İstanbul, Turkey
| | - Orkun Koban
- Department of Neurosurgery, Okan University School of Medicine, İstanbul, Turkey
| | - Ahmet Öğrenci
- Department of Neurosurgery, Okan University School of Medicine, İstanbul, Turkey
| | - Mesut Yılmaz
- Department of Neurosurgery, Neurospinal Academia, İstanbul, Turkey
| | - Sedat Dalbayrak
- Department of Neurosurgery, Okan University School of Medicine, İstanbul, Turkey
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Marwan Y, Dahrab B, Esmaeel A, Ibrahim SA, Al-Failakawi J. Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2017; 27:591-598. [DOI: 10.1007/s00590-016-1896-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 12/23/2016] [Indexed: 11/25/2022]
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Baba-Rasul I, Hama Ameen HM, Khazendar A, Hasan SO. A Rare Case of Isolated Lower Segment Transverse Sacral Fracture in a 12-Year-Old Girl and Its Management by Fixation with K-Wire. World Neurosurg 2016; 97:758.e1-758.e5. [PMID: 27746253 DOI: 10.1016/j.wneu.2016.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 10/02/2016] [Accepted: 10/04/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Isolated lower segment sacral fracture is very rare. To the best of our knowledge, there is only one case report of S4 stable fracture that was treated conservatively. CASE DESCRIPTION Here, we report a 12-year-old girl who sustained an isolated S5 fracture with anterior displacement of S5 and coccyx on S4. The patient initially was managed conservatively 1 month and 25 days. On the failure of this treatment procedure, the patient was treated surgically by partial coccygectomy with S4-S5 fixation after reduction by 2 K-wires. CONCLUSIONS Sacral fracture is difficult to diagnose, especially when the patient has multiple injuries. This is because the emergency doctor may not perform a neurologic examination of the perineum and may miss its diagnosis. Another reason for its misdiagnosis is that the routine anteroposterior plain X-ray may not detect it. Trauma patients with sacrococcygeal pain and tenderness should raise concerns about sacral fracture, and a lateral plain X-ray and/or computed tomography of the sacrococcygeal spine should be performed. Neurologic deficit is rare in lower sacral segment fracture; hence, a trial of conservative management (same as for coccygeal fracture) should be tried first. If the patient does not respond and there is displacement, surgical intervention can be used, because it has a very good response from the patient. In the presence of a neurological deficit, however, surgical intervention should be attempted as soon as possible.
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Affiliation(s)
- Ismaeel Baba-Rasul
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Orthopedics, Surgical Teaching Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Hemin M Hama Ameen
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Awder Khazendar
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital, Sulaymaniyah, Kurdistan, Iraq
| | - Seerwan O Hasan
- Surgical Emergency Hospital, Sulaymaniyah, Kurdistan, Iraq; Department of Neurosurgery, Shahid Doctor Aso Neurosurgical and Ophthalmological Hospital, Sulaymaniyah, Kurdistan, Iraq.
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Wang H, Coppola PT, Coppola M. Orthopedic emergencies: a practical emergency department classification (US-VAGON) in pelvic fractures. Emerg Med Clin North Am 2015; 33:451-73. [PMID: 25892731 DOI: 10.1016/j.emc.2015.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Trauma is one of the leading causes of death before the age of 40 years and approximately 5% of patients with trauma who require hospital admission have pelvic fractures. This article updates the emergency department classification of pelvic fractures first described in 2000. This information is of practical value to emergency physicians in identifying the potential vascular, genitourinary, gastrointestinal, orthopedic, and neurologic complications and further assists them in the initial evaluation and treatment of patients with pelvic fractures.
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Affiliation(s)
- Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, 1500 South Main Street, Fort Worth, TX 76104, USA
| | - Paolo T Coppola
- STAT-Health, 519 W Jericho Turnpike, Smithtown, NY 11787, USA
| | - Marco Coppola
- University of North Texas Health Science Center, 3500 Camp Bowie Boulevard, Fort Worth, TX 76107, USA.
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Abstract
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.
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Affiliation(s)
- S. T. Nathan
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 210 E. Gray Street, Suite 1003, Louisville, Kentucky 40202, USA
| | - B. E. Fisher
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 210 E. Gray Street, Suite 1003, Louisville, Kentucky 40202, USA
| | - C. S. Roberts
- Department of Orthopaedic Surgery, University of Louisville School of Medicine, 210 E. Gray Street, Suite 1003, Louisville, Kentucky 40202, USA
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Kamysz J, Rechitsky M. Pubic Bone Cement Osteoplasty for Pubic Insufficiency Fractures. J Vasc Interv Radiol 2008; 19:1386-9. [DOI: 10.1016/j.jvir.2008.05.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2007] [Revised: 05/21/2008] [Accepted: 05/29/2008] [Indexed: 10/21/2022] Open
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