Transrectal osteopathic manipulation treatment for chronic coccydynia: feasibility, acceptability and patient-oriented outcomes in a quality improvement project

CONTEXT

Pain of the coccyx, coccydynia, is a common condition with a substantial impact on the quality of life. Although most cases resolve with conservative care, 10 % become chronic and are more debilitating. Treatment for chronic coccydynia is limited; surgery is not definitive. Osteopathic manipulative treatment (OMT) is the application of manually guided forces to areas of somatic dysfunction to improve physiologic function and support homeostasis including for coccydynia, but its use as a transrectal procedure for coccydynia in a primary care clinic setting is not well documented.

OBJECTIVES

We aimed to conduct a quality improvement (QI) study to explore the feasibility, acceptability, and clinical effects of transrectal OMT for chronic coccydynia in a primary care setting.

METHODS

This QI project prospectively treated and assessed 16 patients with chronic coccydynia in a primary care outpatient clinic. The intervention was transrectal OMT as typically practiced in our clinic, and included myofascial release and balanced ligamentous tension in combination with active patient movement of the head and neck. The outcome measures included: acceptance, as assessed by the response rate (yes/no) to utilize OMT for coccydynia; acceptability, as assessed by satisfaction with treatment; and coccygeal pain, as assessed by self-report on a 0-10 numerical rating scale (NRS) for coccydynia while lying down, seated, standing, and walking.

RESULTS

Sixteen consecutive patients with coccydynia were offered and accepted OMT; six patients also received other procedural care. Ten patients (two males, eight females) received only OMT intervention for their coccydynia and were included in the per-protocol analysis. Posttreatment scores immediately after one procedure (acute model) and in follow-up were significantly improved compared with pretreatment scores. Follow-up pain scores provided by five of the 10 patients demonstrated significant improvement. The study supports transrectal OMT as a feasible and acceptable treatment option for coccydynia. Patients were satisfied with the procedure and reported improvement. There were no side effects or adverse events.

CONCLUSIONS

These data suggest that the use of transrectal OMT for chronic coccydynia is feasible and acceptable; self-reported improvement suggests utility in this clinic setting. Further evaluation in controlled studies is warranted.

Ultrasound-Guided Coccygeal Nerve Radiofrequency Ablation and Steroid Injection: Combination Therapy for Coccydynia

OBJECTIVES

Coccydynia is characterized by pain in tailbone region, which affects the quality of life. Various interventional procedures are performed for coccydynia that is unresponsive to conservative treatment. This study aimed to evaluate the efficacy of ultrasound (US)-guided radiofrequency ablation (RFA) and steroid injection of the coccygeal nerve in patients with idiopathic and traumatic coccydynia.

METHODS

In this prospective study, 32 patients with coccydynia unresponsive to conservative treatments underwent US-guided RFA of the coccygeal nerve. Coccygeal nerves were visualized at the level of the coccygeal cornua with US, 1 mL lidocaine 2% was injected into both areas and radiofrequency ablation was performed at 90°C for 60 seconds. After RFA, 2 mL dexamethasone and 2 mL bupivacaine 0.5% were injected. Visual Analog Scale (VAS) and Paris scales were used to evaluate the effect of treatment on pain and functionality before and at 1, 4, and 12 weeks after treatment.

RESULTS

We found that 54% of the patients had a >50% reduction in VAS score and 66% of the patients had a >50% reduction in Paris scores measured between baseline and week 12. Additionally, the main effect of time on the VAS and Paris scores was statistically significant (P < .001) in all measurements. Baseline P and VAS scores were higher than the post-treatment measurements (P < .001).

CONCLUSIONS

Our study showed that US-guided steroid injection and RFA of the coccygeal nerve for chronic coccydynia significantly improved pain and function scores at weeks 1, 4, and 12. RFA also results in a lower rate of adverse events. This study is the first clinical trial of ultrasound-guided coccygeal nerve RFA in patients with coccydynia. We believe that this new less invasive method may be an alternative to other interventional treatments.

Radial extracorporeal shockwave therapy (rESWT) for coccydynia: a prospective study of 14 patients

Background

Coccydynia is defined as pain in the coccyx. We investigated the effect of radial extracorporeal shockwave therapy (rESWT) in the management of coccydynia.

Methods

In this prospective study, patients (≥18 years) diagnosed with coccydynia at a sports clinic located in Thessaloniki, Greece, were eligible for rESWT treatment when they reported a visual analogue scale (VAS) pain level ≥6. Treatment sessions were once weekly and ended when VAS pain levels decreased to ≤3. Recurrence rates were documented at 3-month and 12-month follow-ups.

Results

Fourteen patients were treated using rESWT. The mean age and symptom duration of our cohort was 33.6±7.9 (range: 20-45) years and 9.4±8.5 (range: 3-36) months, respectively. The mean number of treatment sessions per patient was 6.4±1.6 (range: 4-8). The mean device pressure, frequency, and number of pulses was 1.2±0.1 (range: 1-1.4) bar, 5.0±0.1 (range: 5-6) Hz, and 2082±74.8 (range: 2000-2300) pulses, respectively. Treatment alleviated pain in all patients, and no recurrence of symptoms was reported during follow-up. There was a positive correlation between symptom duration and the number of treatment sessions (r=0.701, P=0.005). Pairwise comparison highlighted significant reductions in VAS pain levels between each stage of treatment (P<0.001).

Conclusion

Our study affirms the safety and efficacy of rESWT in managing coccydynia.

Evaluation of accuracy, reliability, quality, and readability of online patient information materials on coccyx injury

The aim of this research is to evaluate the websites containing "coccydynia, coccyx trauma or fracture" in terms of readability, reliability, accuracy, and quality. Searches for "coccydynia, coccyx trauma, coccyx fracture" were carried out in the 3 most used search engines in the USA: Google, Yahoo, and Bing in February 2022. A total of 141 websites were rated by 2 different neurosurgeons for the "Global Quality Score" and "Alexa Popularity Rank." 97.2% of the sites examined include the definition of the disease, 66% include the importance of the disease, 92.9% include the symptoms of the disease, 88.7% include the treatment of the disease, 78% include the signs of the disease, 77.3% include the mechanism of the disease It has been determined that the websites examined within the scope of the research have high global quality score (GQS) and APR and are enriched with images to a large extent.

Ganglion Impar Block: A Magic Bullet to Fix Idiopathic Coccygodynia

Coccygodynia (coccydynia) is a painful condition of the perineum in the region of the tailbone or coccyx, aggravated by sitting on hard surfaces. It is frequently associated with injuries to the coccyx following direct trauma. Nevertheless, idiopathic coccygodynia without antecedent trauma history is not uncommon. Most of these patients respond to anti-inflammatory medications and physical therapy. Those who are unresponsive may require additional intervention for pain relief. Blockade of ganglion impar, the terminal end of the pelvic sympathetic chain, can dramatically alleviate the pain in patients suffering from coccygodynia. In the current case series, four patients in the age range of 21 to 69 years suffering from chronic idiopathic coccygodynia (female: male ratio of 1:1) were treated with ganglion impar block. All four patients received a course of medical management, and two of the patients additionally received local infiltration of the coccyx before ganglion impar block administration. The block was performed with fluoroscopy guidance by either the trans-sacrococcygeal joint approach or the intra-coccygeal joint approach. The pre-intervention average numeric rating pain score (NRS) was 7.5. After a single ganglion impar block intervention, all four patients experienced complete pain relief (NRS=0). No patients required a repeat injection, and all were pain-free for the entire one-year follow-up period.

Clinical Outcomes of Coccygectomy for Coccydynia: A Single Institution Series With Mean 5-Year Follow-Up

BACKGROUND

Prior studies of coccygectomy consist of small patient groups, heterogeneous techniques, and high wound complication rates (up to 22%). This study investigates our institution's experience with coccygectomy using a novel "off-center" wound closure technique and analyzes prognostic factors for long-term successful clinical outcomes.

METHODS

Retrospective review of all patients who underwent coccygectomy from 2006 to 2019 at a single center. Demographics, mechanism of injury, conservative management, morphology (Postacchini and Massobrio), and postoperative complications were collected. Preoperative and postoperative Oswestry Disability Index (ODI), visual analog scale (VAS), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), and EuroQol-5D (EQ-5D) were compared. Risk factors for failing to meet minimum clinically importance difference for ODI and PROMIS-physical function/pain interference were identified. Risk factors for remaining disabled after surgery (ODI <20) and factors associated with VAS and EQ-5D improvement were investigated using stepwise logistic regression.

RESULTS

A total of 173 patients (77% women, mean age = 46.56 years, mean follow-up 5.58 ± 3.95 years). The most common etiologies of coccydynia were spontaneous/unknown (42.2%) and trauma/accident (41%). ODI, VAS, and several PROMIS-29 domains improved postoperatively. Older age predicted continued postoperative disability (ODI <20) and history of prior spine surgery, trauma etiology, and women had inferior outcomes. No history of spine surgery (cervical, thoracic, or lumbar) prior to coccygectomy was found to predict improved postoperative VAS back scores. No outcome differences were demonstrated among the coccyx morphologies. Sixteen patients (9.25%) were noted to have postoperative infections of the incision site with no difference in long-term outcomes (all P <0.05).

CONCLUSIONS

This is the largest series of coccygectomy patients demonstrating improvement in long-term outcomes. Compared to previous studies, our cohort had a lower wound infection rate, which we attribute to an "off-center" closure.

CLINICAL RELEVANCE

Patients should be counseled that their surgical history, along with age, gender, and etiology of pain can influence success following coccygectomy. These data can help surgeons set realistic expectations following surgery.

LEVEL OF EVIDENCE

3.

Coccygectomy for Chronic Refractory Coccygodynia in Pediatric and Adolescent Patients

Aims:

Coccygodynia (also known as coccydynia and coccyalgia) described for the first time by Simpson in 1859. It is a disabling pain in the coccyx usually provoked by sitting or changing position from a sitting to a standing position. Treatment started with adjustment of ergonomics as specialized cushion for sitting, application of local heat, and oral analgesics. The aim of this study was to assess the results of total or partial coccygectomy for patients suffering from chronic refractory coccygodynia and not improving on conservative treatment in pediatrics and adolescents.

Methods:

The study included 22 patients, 8 of them with chronic refractory coccygodynia not responding to conservative management underwent partial or total coccygectomy using Key's surgical exposure after good preoperative preparation.

Results:

This study included 5 females (62.5%) and 3 males (37.5%), their ages ranged from 7 to 15 years. The results were excellent in 75% of patients and good in the remaining cases. The mean length of hospital stay was 1.43 ± 0.98 days. No significant intraoperative or postoperative complications were reported. The parents were satisfied in almost all cases in the long term follow up.

Conclusions:

Coccygodynia is a disabling problem, especially in pediatric patients. Coccygectomy is a feasible management option and has a favorable outcome when performed for an appropriate indication.

Enhanced Spinal Therapy: Extracorporeal Shock Wave Therapy for the Spine

Extracorporeal shock wave therapy (ESWT) is a non-invasive therapeutic method used for pain management and muscle strength improvement through the use of shock waves. In vitro studies have demonstrated that shockwave therapy induces fluctuation in redox reaction regulation and increases in Mitogen-Activated Protein Kinase (MAPK) signal transduction pathways, stimulating increased gene expression in the nucleus. ESWT has also been shown to upregulate angiogenesis and growth factors through activation of endothelial nitric oxide synthase (eNOS) and vascular endothelial growth factor (VEGF). The use of ESWT in the treatment of various musculoskeletal disorders was widely adopted throughout Europe, South America, and Asia before being introduced in the United States in 2000. Within the past 20 years, the clinical application of ESWT in the treatment of musculoskeletal and bone disorders has grown. This paper provides a comprehensive narrative review of applications and outcomes of ESWT in clinical spinal pathology and assesses reported efficacy as it relates to the pathology. A review of the literature yielded studies describing the use of ESWT in degenerative osteoporotic neuro-spinal pathology, heterotopic ossification due to spinal cord injury, cervical spondylosis, scoliosis, sacroiliitis, and coccydynia. The efficacy of ESWT as an adjunct treatment in patients with spinal cord pathologies varied with the specific pathology, however, all pathologies discussed in this review provided evidence of potential benefits with minimal adverse effects. While the use of ESWT for pain management has widely been established, further literature should aim to identify the long-term benefits of ESWT.

Efficacy of pulsed radiofrequency in controlling pain caused by spinal disorders: a narrative review

Pulsed radiofrequency (PRF) stimulation has been safely and effectively applied for controlling various types of pain. Here, we aimed to systematically review the literature pertaining to the efficacy of PRF stimulation for managing pain associated with spinal disorders. We conducted a PubMed search for papers published until August 20, 2019, that used PRF to treat pain resulting from spinal disorders. The following inclusion criteria were applied when selecting the articles: (I) patients' pain was caused by spinal disorders; (II) PRF stimulation was applied on the spinal structure; and (III) after PRF stimulation, follow-up evaluation was performed to assess the change in pain intensity. Review articles were excluded. The primary literature search yielded 168 relevant papers. After reading their titles and abstracts and evaluating their eligibility based on the full-text articles, we finally included 59 publications in this review. The therapeutic outcomes reported in the selected studies showed that PRF is an effective treatment for cervical and lumbar radicular pain. Similarly, PRF stimulation seems to be effective for treating cervical joint (cervical facet and atlantoaxial joints) pain and lumbar facet joint pain. PRF stimulation has also resulted in positive outcomes in some studies, in which patients were treated for other disorders, including cervicogenic headache, discogenic neck pain, thoracic facet joint pain, discogenic back pain, and coccydynia. Nevertheless, there is insufficient evidence for the efficacy of PRF stimulation in these disorders. In conclusion, our review provides insights into the degree of evidence available on the effectiveness of PRF stimulation for treating pain associated with each of the spinal disorders reviewed. This information will help clinicians make informed decisions on using PRF stimulation to treat various spinal conditions and manage the associated pain.

Laser acupuncture for refractory coccydynia after traumatic coccyx fracture: A case report

RATIONALE

Coccyx fracture is an injury usually caused by trauma. In most cases, the fractures recover after conservative therapy. For refractory cases that exhibit coccydynia after more than 2 months of conservative treatment, coccygectomy is indicated. However, limited information about the efficacy of this procedure is available, and it is known to have a high complication rate. As such, other therapeutic approaches are needed. Here, we report our experience using another conservative treatment option, low-level laser therapy, to successfully reduce refractory coccydynia in a patient with coccyx fracture.

PATIENT CONCERNS

A 23-year-old woman had refractory coccydynia and increased pain after a traffic accident-induced coccyx fracture.

DIAGNOSES

Initially, the patient reported transient improvement after conservative treatment with non-steroidal anti-inflammatory drugs. However, the pain increased in severity (numerical rating scale score of 8) soon after she resumed work in her office, and progressed in the following 2 months. Surgical intervention was suggested owing to the prolonged coccydynia following the failure of conservative treatment and difficulties in performing daily life activities. However, she sought other conservative therapy options, because she was concerned about the risks associated with the coccygectomy surgery.

INTERVENTIONS

The patient received low-level laser therapy once a week, for 24 weeks.

OUTCOMES

After 11 weeks of treatment, the patient reported significant improvements in her symptoms; her pain was reduced to a numerical rating scale score of 2 and bone healing was noted on radiographs. The patient could eventually perform her daily activities satisfactorily, without coccydynia, after 24 weeks of treatment.

LESSONS

Laser acupuncture produced analgesic effects in this patient with refractory coccydynia after traumatic coccyx fracture. This is the first case report to apply laser acupuncture for refractory coccydynia after traumatic coccyx fracture. Our findings imply that laser acupuncture may be a good conservative therapy option for coccyx fracture.

Platelet-rich plasma for the treatment of coccydynia: a case report and review of regenerative medicine for coccydynia

Aim: To describe the successful treatment of coccydynia using ultrasound-guided injection of platelet-rich plasma. Setting: Outpatient orthopedic practice. Patient: 17-year-old female with BMI of 42.6. Case description: The patient presented with 6 months of nontraumatic coccygeal pain exacerbated by sitting. Physical exam was significant for point-tenderness over the sacral hiatus and coccyx. A corticosteroid injection around the sacrococcygeal ligament was administered with immediate resolution of her pain following the injection with the anesthetic. The patient reported significant pain relief for 1 week. The superficial sacrococcygeal ligament was then treated with a platelet-rich plasma injection under US guidance. Results: The patient reported a 70% improvement in pain and sitting tolerance at 6 weeks. By 6 months post injection, her pain was 100% resolved, and she remained pain free at the 12-month follow-up. Conclusion: Platelet-rich plasma may be considered as a treatment option in patients with refractory coccydynia.

Effects of kinesiotaping and exercise program on patients with obesity-induced coccydynia: a randomized, double-blinded, sham-controlled clinical trial

OBJECTIVE

To investigate the effect of kinesiotaping and a designed exercise program versus sham kinesiotaping and the same exercise program on pain, range of motion, and activities of daily living in obese patients suffering from coccydynia.

DESIGN

A double-blinded, randomized, sham-controlled trial.

SETTING

Outpatient, Cairo University hospitals.

PARTICIPANTS

Sixty patients with coccydynia randomized equally into kinesiotape plus exercise and sham kinesiotape plus exercise groups.

INTERVENTION

The kinesiotape was worn for three days and replaced for three weeks. Each patient practiced exercises for three weeks.

OUTCOME MEASURES

All patients were examined by visual analogue scale (VAS) for rating pain, Modified Modified Schober Test (MMST), and Oswestry Disability Index (ODI). All outcomes were measured at baseline, three weeks postintervention, and four weeks follow-up.

RESULTS

There were no statistically significant differences between groups at baseline (P < 0.05), but there were statistically significant differences between groups for pain score, MMST, and ODI at post and follow-up data in favor of the kinesiotape group (P < 0.001). For the three weeks postintervention, mean (SD) for pain score, MMST, and ODI was 33.07 ± 3.8, 6.6 ± 0.7, and 8.7 ± 2.1 in the study group and 39.9 ± 4.7, 5.8 ± 1.4, and 14.4 ± 2.7 in the control group, respectively. For the four weeks follow-up, mean (SD) for pain score, MMST, and ODI was 32.2 ± 3.4, 7.13 ± 0.6, and 7.2 ± 1.8 in the study group and 40.9 ± 4.4, 6.6 ± 0.75, and 13 ± 2 in the control group, respectively.

CONCLUSION

Experimental kinesiotape intervention and exercise program provided significant improvements in pain, range of motion, and disability. It is suggested as an adjunctive therapy in treating obese patients with coccydynia.

Outcomes of Coccygectomy Using the "Z" Plasty Technique of Wound Closure

STUDY DESIGN

Technical note.

OBJECTIVES

Coccygectomy for chronic coccydynia has a high rate of successful clinical outcome. However, the procedure is associated with increased incidence of wound dehiscence and surgical site infection. The main objective was to evaluate the clinical outcomes of coccygectomy using the Z plasty technique of wound closure.

METHODS

Patients with chronic coccydynia refractory to conservative treatment underwent coccygectomy followed by Z plasty technique of wound closure between January 2013 and February 2018. Primary outcome measure was evaluation of the wound healing in the postoperative period and at follow-up; secondary outcome measure included visual analogue scale (VAS) score for coccygeal pain.

RESULTS

Ten patients (male:female 6:4) fulfilled the inclusion criteria. The mean age of patients was 40.78 years (range 19-55 years). The mean follow-up was 1.75 years (range 6 months to 5 years). All wounds healed well with no incidence of wound dehiscence or surgical site infections. The mean VAS improved from 7.33 ± 0.5 to 2.11 ± 1.2 (P < .05). Nine patients reported excellent outcomes and 1 patient reported poor outcome with regards to relief from coccydynia.

CONCLUSION

Z plasty technique of wound closure is recommended as procedure of choice to avoid wound healing problems and surgical site infections associated with coccygectomy. Coccygectomy remains a successful treatment modality for chronic coccydynia.

The influence of coccygeal dynamic patterns on ganglion impar block treatment results in chronic coccygodynia

Objective Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Patients were assessed with standard and dynamic coccyx radiographs and classified according to coccygeal mobility. Pain scores were assessed with a numerical rating scale (NRS) before and after the intervention (at 1 hour and 4, 12 and 24 weeks). A 50% or more reduction in the NRS score was accepted as significant pain relief. Results Of the 37 patients included in the study, 14 had normal coccyx (Group I) and 23 had immobile coccyx (Group II) based on the radiological evaluation. The NRS scores were significantly reduced in both groups on each follow-up visit but there was no significant difference between the two groups in terms of pre- and post-intervention NRS scores. Significant pain relief was achieved in 42.9% and 61.9% of patients in Group I and II at the last examination, respectively. Conclusion GIB administered by transsacrococcygeal method in patients with chronic coccygodynia is a safe and alternative treatment approach with reduced pain scores and low complication rates. In patients with chronic coccygodynia, having a normal or immobile coccyx does not appear to affect treatment outcomes.

Tailbone Pain from Coccyx Injuries on Water Slides: A Case Series

BACKGROUND

Water slides and rides are increasingly popular attractions at amusement parks. There has been some documentation of various patterns of injury associated with these rides, most notably vaginal injuries caused by water jets. But we find no previous medical publications reporting the association between water slides/rides with coccydynia (coccyx pain) and tailbone injuries.

CASE REPORT

Our purpose in this case report was to assess for an association between water slides/rides with injuries to the coccyx causing coccyx pain. We conducted a retrospective chart review in a coccyx pain clinic on a medical school campus at a level I trauma center. The retrospective chart review took place over a 2-year period and encompassed 217 new patients. Four patients presenting to our coccyx pain clinic had either onset or exacerbation of symptoms with temporal relationship to water slide or ride activities. Three of 4 patients had abnormal dynamic instability on radiologic dynamic imaging, including standing versus seated radiographs and magnetic resonance imaging. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Recreational water slides/rides are a newly reported cause of coccygeal dynamic instability with resultant tailbone pain. Dynamic imaging studies (sitting vs. standing) of the coccyx should be considered in patients with coccyx pain after injuries on a water slide or ride. Many of these patients may initially seek care from emergency physicians.

Radiofrequency Thermocoagulation of the Ganglion Impar for Coccydynia Management: Long-Term Effects

OBJECTIVE

To investigate the short- and long-term effects of ganglion impar radiofrequency thermocoagulation (RFT) treatment in patients with chronic coccydynia.

METHODS

We retrospectively analyzed the medical records of patients who underwent RFT of the ganglion impar between 2009 and 2011. Pain intensity visual numeric scale (VNS) scores and Euroqol 5D (EQ-5D) index scores were recorded pre-intervention and post-intervention at the first, sixth, and twelfth months. The differences between pre-procedural VNS scores and post-procedural VNS scores at the first, sixth, and twelfth months were evaluated. The success of the intervention was recorded as the percentage difference between the pre-intervention VNS scores and post-intervention VNS scores at the first, sixth, and twelfth months.

RESULTS

The mean age of the patients, including 11 females (55%) and 8 males (45%), was 48.7 ± 14.3 years. The average follow-up duration was 17.3 ± 2.9 months. Statistically significant differences were observed between the pre- and post-procedure VNS scores (P < 0.0001). Improvements in VNS scores were correlated with improvements in EQ-5D index scores. Mid-term (sixth month) and long-term (twelfth month) evaluations after the intervention revealed that 67.4% and 61.1% of the patients had successful outcomes, respectively.

CONCLUSION

Our data suggested that RFT of the ganglion impar in patients with chronic coccydynia resulted in effective outcomes, and patients who responded to RFT had significantly lower post-RFT pain scores.

Sclerosing Epithelioid Fibrosarcoma of the Coccyx: A Case Report and Review of Literature

Coccydynia in adult patients is not uncommon and is frequently neglected. Coccydynia is mostly associated with fall on buttocks. In long-standing cases, coccydynia can be debilitating. Rarely coccydynia can be due to more sinister causes and surgeons should be aware of all differential diagnosis. We present a case of an elderly female who presented with a complaint of pain over coccyx which was not subsiding with conventional treatment methods. Biopsy was done and a diagnosis of sclerosing epitheloid fibrosarcoma was made. We describe an unusual case of coccydynia secondary to this tumour with the histopathology finding and surgical management.

Transsacrococcygeal approach to ganglion impar: radiofrequency application for the treatment of chronic intractable coccydynia

Objective

Coccydynia is defined as pain in the coccygeal region. Among the many causes of coccydynia, the most common cause is trauma as a result of falling on the buttocks, repetitive microtrauma, or childbirth. Several methods are currently used for the treatment of coccydynia, including nonsteroidal anti-inflammatory drugs, intrarectal manipulation, epidural injections, ganglion impar blocks, and radiofrequency treatment (RFT). Wemm and Saberski used the transacrococcygeal methods to reduce tissue trauma. RFT is a percutaneous minimally invasive procedure. In this study, we aimed to assess the effect of the transsacrococcygeal approach on ganglion impar RFT in patients with chronic coccydynia.

Methods

We retrospectively examined the data of 41 patients at the Department of Anesthesiology and Reanimation, Faculty of Medicine, Maltepe University (Pain Clinic), between January 1, 2010, and December 31, 2012.

Results

The mean age of the patients was 46.68±11.00 years (range 28–67 [46] years). The average pain duration was 3.10±1.37 years. The difference between visual analog scale scores of the pre-and postprocedure was statistically significant. In the examinations carried out in the sixth month of the treatment, 90.2% of patients had a successful outcome, whereas treatment failed in 9.8% of patients. According to our patients’ data, most of them had pain due to a trauma, were female, and overweight. Visual analog scale difference between preprocedure and early postprocedure, preprocedure and first month, preprocedure and sixth month were statistically significant (P=0.001).

Conclusion

Based on the lower pain scores and low complication rates after the operations, the results suggest that application of RFT on ganglion impar by the transsacrococcygeal approach is an effective and safe method for the treatment of chronic coccydynia. Patient selection, technique, and experience are the most important factors affecting the success of this method.

One is the loneliest number: a review of the ganglion impar and its relation to pelvic pain syndromes

The ganglion impar is often overlooked as a component of the sympathetic nervous system. Despite its obscurity, this ganglion provides a pathway for neurons by accommodating postganglionic sympathetics, visceral afferents, and somatic fibers traveling to and from the pelvis. Its classic anatomic location as described in the 1720's held up until recently, with the current literature now revealing a great deal of anatomical variability. This variation becomes important when the ganglion impar is used as a treatment target for patients with chronic pelvic pain - its primary clinical implication. The aim of this review was to provide a better understanding of the anatomy of ganglion impar, accounting for variation in size, shape, and location. In addition, the clinical importance and treatment modalities associated with the ganglion impar are outlined.