Coccygectomy for coccydynia: case series and review of literature.

STUDY DESIGN: This is a case series in which case notes review and telephone interview update were used to assess the outcome following coccygectomy. OBJECTIVE: To correlate the clinical results of coccygectomy with histology and discography of the sacrococcygeal and intercoccygeal segments. SUMMARY OF BACKGROUND DATA: Clinicians regard chronic disabling pain in the sacrococcygeal region with much dismay because of the reputed unpredictability of the treatment outcome. METHODS: A total of 38 patients had coccygectomy for intractable coccydynia, and 31 were available for follow-up. The excised specimen with intact sacrococcygeal joint was sent for histologic examination in 22 patients. There were 6 patients investigated using sacrococcygeal and intercoccygeal discography. RESULTS: Mean postoperative follow-up was 6.75 years (range 2-16). There were 16 patients who benefited highly from the surgery, and 6 benefited to some extent, giving an overall beneficial result of 71%. Of all specimens, 86.3% had histologic changes of degeneration. Moderate-to-severe degenerate changes in sacrococcygeal and intercoccygeal joints on histology were found in 54.5% of patients. Of these patients, 83.3% did well with surgery. Only 57.1% of those patients with mild changes did well. There were 2 patients who had positive discography, and both did well with surgery. Three patients had negative diskographies, and 2 of them had a poor result, and 1 had only some relief. CONCLUSIONS: It is possible that degenerate changes in sacrococcygeal discs and/or intercoccygeal discs are associated with pain. Surgical results are better in those with a severe degree of degenerative change. Coccygectomy remains a successful treatment for a majority of severely disabled patients with coccydynia.

Bilateral fractured neck of the femur in an adult patient with cystic fibrosis.

A 34-year-old man with cystic fibrosis (CF) sustained a bilateral fractured neck of the femur during the course of six grand mal seizures. The fractures were successfully treated with bipolar hemi-arthroplasties. Several risk factors for osteoporosis were present. Bone pathology showed reduced femoral head bone density. Osteoporosis of the lumbar spine was confirmed by dual-energy X-ray absorptiometry. As the life expectancy of patients with CF continues to improve, osteoporosis and its sequelae will become more common. We should be aware of the increased risk of bilateral fractured neck of the femur following epileptic seizure in CF.

Autologous chondrocyte implantation for cartilage repair: monitoring its success by magnetic resonance imaging and histology.

Autologous chondrocyte implantation is being used increasingly for the treatment of cartilage defects. In spite of this, there has been a paucity of objective, standardised assessment of the outcome and quality of repair tissue formed. We have investigated patients treated with autologous chondrocyte implantation (ACI), some in conjunction with mosaicplasty, and developed objective, semiquantitative scoring schemes to monitor the repair tissue using MRI and histology. Results indicate repair tissue to be on average 2.5 mm thick. It was of varying morphology ranging from predominantly hyaline in 22% of biopsy specimens, mixed in 48%, through to predominantly fibrocartilage, in 30%, apparently improving with increasing time postgraft. Repair tissue was well integrated with the host tissue in all aspects viewed. MRI scans provide a useful assessment of properties of the whole graft area and adjacent tissue and is a noninvasive technique for long-term follow-up. It correlated with histology (P = 0.02) in patients treated with ACI alone.