Coccygectomy for refractory coccydynia, old-fashioned but effective procedure: A retrospective analysis.

PURPOSE: Coccydynia, characterized by persistent pain in the coccygeal region, significantly impacts patients' quality of life. While various treatment modalities exist, including conservative measures and surgical interventions like coccygectomy, optimal management remains unclear. This retrospective cohort study aimed to compare the clinical outcomes, functional improvements, and quality of life in patients with chronic coccydynia undergoing either infiltrative treatment or coccygectomy. METHODS: Data from patients treated at our institution from January 2018 to December 2022 were analyzed. Participants meeting inclusion criteria were divided into two groups: Group A underwent coccygectomy, while Group B received conservative therapy. Clinical assessments, radiographic evaluations, and patient-reported outcomes were collected preoperatively and at follow-up intervals. RESULTS: Of the 223 initially examined patients, 55 met inclusion criteria. Group A (n = 21) underwent coccygectomy, while Group B (n = 34) received conservative therapy. Both groups showed significant pain reduction post-intervention, with sustained improvement in Group A. Functional outcomes favoured Group A, with significant improvements in disability and quality of life measures. Complications were minimal, with only one case of superficial wound infection in Group A. CONCLUSION: Our findings suggest that coccygectomy provides superior and lasting pain relief, functional improvement, and quality of life improvement compared to conservative therapy. While complications were minimal, further research with larger cohorts is warranted to validate these results and explore long-term outcomes. Despite its historical association with complications, advancements in surgical techniques and perioperative care have led to improved outcomes and reduced complication rates. Thus, coccygectomy should be considered in the treatment algorithm for patients with debilitating coccydynia.

[Treatment options for coccygodynia]. / Therapieoptionen bei der Coccygodynie.

BACKGROUND: To this day, patients with coccyx problems are the most frequently underestimated patient population in orthopedic practices. The clinical picture of coccygodynia was first described in 1859. Nevertheless, discussions about the importance of coccyx problems remain a tiresome topic. All patients have in common that they have gone through a long ordeal with many therapists, examinations and therapeutic approaches without having received a real diagnosis. DIAGNOSTIC: The main symptom of coccygodynia is the pain directly on the lowest segment of the coccyx, which often only occurs when sitting and is intensified by the change in position, usually from a sitting to a standing position. Trauma can only be described as the trigger in 50% of cases. Women are four times more likely to be affected than men. The gold standard for imaging should be viewed from standing and seated dynamic lateral radiographs of the coccyx. TREATMENT: After the diagnosis has been made, conservative treatment should first be started with oral NSAIDs, relief with a coccyx cushion with a recess and, if necessary, physiotherapy to strengthen or loosen the pelvic floor. Local infiltrations with a glucocorticoid and local anesthetic directly in the painful area are also often promising. If the symptoms persist for more than 6 months, surgical treatment in the sense of removing the coccyx can be discussed with the patient. The literature shows a success rate of 80-90% if the indication was correct.

Mind the gap: paramedian approach for coccygectomy.

BACKGROUND CONTEXT: Coccydynia is pain in the coccyx that typically occurs idiopathically or from trauma. Most forms are self-limiting. However, if symptoms persist, nonsurgical treatment options can include offloading, NSAIDs, physical therapy, and steroid injections. If all treatment options fail, a growing body of evidence supports a coccygectomy for symptomatic relief. The standard approach for a coccygectomy involves a midline incision cephalad to the anus along the gluteal cleft. Historically, this method has had high rates of infection. PURPOSE: To improve healing and decrease infection rate, we propose the paramedian approach to a coccygectomy. This approach has the benefit of distancing the surgical site from the anus, diminishing the crevice effect of the incision, and increasing the dermal and subdermal thickness for improved surgical closure. STUDY DESIGN/SETTING: We present a case series study of 41 patients who underwent the paramedian approach coccygectomy using a 4 to 6 cm incision, approximately 0.5 to 1.5 cm lateral to the midline, for coccyx removal. These patients were evaluated postoperatively to determine infection rate and various outcome measures. PATIENT SAMPLE: Forty-one patients suffering from refractory coccydynia had a coccygectomy via the paramedian approach between 2011 and 2022 by the senior author. OUTCOME MEASURES: Outcome measures included self-reported measures (Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) pain scale and satisfaction with procedure), physiologic measures (presence of infection and treatment provided) and functional measures (return to vocation/avocation). METHODS: Data was compiled and transferred to Microsoft Excel and analyzed. Two-tailed T-tests were used to compare the patient improvement in VAS and ODI as appropriate for statistical analysis. RESULTS: The patients' average age was 45.8 years. Patients' average body mass index was 27.9, with 71% of patients overweight or obese. A total of 68% of patients were female. Trauma was the most common precipitating factor (75.6%). Five patients presented with postoperative complications (12.1%), one requiring an incision and drainage, and four others were treated with antibiotics for wound erythema. Postoperative evaluations showed continual improvement, with the most significant improvement reported greater than 1-year postoperatively. The Visual Analogue Scale for pain dropped from 7.5 to 2.3 (p<.001), and the Oswestry Disability Index improved from 30.1 to 9.6 (p<.001). A total of 86.7% of patients reported either a good or excellent result. CONCLUSION: Coccygectomies via the midline approach have a variable infection rate, likely due to proximity of the incision to the anus and due to the crevice effect of the gluteal cleft in terms of aeration. These contributing factors are overcome in the paramedian approach, making it an effective option for treating refractory coccydynia that is nonresponsive to conservative management.

Iatrogenic rectal perforation after coccygeal radiofrequency ablation.

Coccygodynia (pain of the coccygeal bone) can be treated locally with anti-inflammatory drugs, local steroid injections, surgical removal of the coccyx and, more recently, with radiofrequency thermal ablation. Complications, such as perforation of the colon, can occur as a consequence of the close relationship between the rectum and the sacrococcyx and with the heat from the thermal ablation expanding to the surrounding tissue causing delayed damage with severe consequences. The treatment of this complication requires the combined effort of the gastrointestinal surgeon as well as a gastroenterologist. In this case report, we describe the treatment of this complication and the clinical course after a perforation of the rectum due to thermal ablation of the coccyx to treat long-standing coccygodynia.

Coccydynia: A Review of Anatomy, Causes, Diagnosis, and Treatment.

¼ Coccydynia is a painful condition affecting many patients at the terminal caudal end of the spine.¼ 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.¼ Several treatment options exist. Successful outcomes for patients depend on individual patient characteristics and the etiology of pain.

Imaging study of coccygeal morphology in adolescent idiopathic scoliosis.

The correlation between scoliosis and sagittal curvature of the cervical, thoracic, and lumbar spine have already been reported in previous studies. However, as a part of the spine, the change in coccygeal morphology in AIS patients has not yet been studied. In this study, a retrospective analysis was performed on 400 patients who were divided into a non-scoliotic group (206 patients) and an AIS group (194 patients). The Postacchini coccygeal radiological classification that was modified by Nathan was used to observe and compare the sagittal coccygeal morphology between the two groups. The results showed that the non-scoliotic group had the highest percentage (52.4%) of patients with type I and the lowest (3.4%) proportion of patients with type V; moreover, the AIS group had the highest percentage (69.1%) of patients with type I and the lowest (1.5%) proportion of patients with type V. The coccygeal morphology was significantly different between the non-scoliotic group and the AIS group (P = 0.001). No significant differences in coccygeal morphology were found between the males and females in the two groups (mild and moderate scoliosis and different segmental scoliosis). In addition, a significant correlation between coccygeal morphology and scoliosis (P = 0.035) was found. In conclusion, coccygeal morphology significantly differs between AIS patients and non-scoliotic adolescents. There was a smaller proportion of patients with a type I coccyx and a larger proportion of patients with a type II or type III coccyx in the AIS group than in the non-scoliotic group. In other words, the presence of a more pronounced coccygeal curve in AIS patients may be caused by an incorrect sitting position and an imbalance in the contraction of the pelvic muscles. It should be further studied whether correcting the sitting position and muscular imbalances could change coccygeal morphology and subsequently affect the development of AIS.

Angiolipoma sacro. Reporte de un caso / Sacral angiolipoma. A case report

Fundamento: Los angiolipomas son tumores benignos que se presentan en adultos con una localización,preferentemente, en el espacio epidural posterior torácico.Objetivo: Presentar un caso que debutó con un traumatismo axial lumbosacro donde se evidenció unalocalización poco común de la lesión y sin relación con las estructuras del canal raquídeo.Presentación del caso: Hombre de 25 años que se cayó y debido a ello se le hizo un traumatismo directo en laregión sacrococcígea con dolor y aumento de volumen regional, asociado a parestesias glúteas. Los estudiosradiológicos evidenciaron una fractura del cóccix y la presencia de una lesión ubicada en las partes blandas, deaspecto redondeado, homogéneo, sólido, de poco más de 50 mm de diámetro. Se le realizó tratamiento quirúrgicoque consistió en coccigectomía subperióstica y exéresis macroscópica de la masa. El estudio histológico concluyóel diagnóstico de un angiolipoma.Conclusiones: Los angiolipomas son tumores raros que tienen características radiológicas peculiares, requierende alta sospecha clínico-imagenológica para indicar los estudios y el tratamiento. La exéresis total esrecomendada para evitar la recurrencia y mejorar el pronóstico. [AU]

Angiolipoma sacro. Reporte de un caso / Sacral angiolipoma. A case report

Fundamento: Los angiolipomas son tumores benignos que se presentan en adultos con una localización, preferentemente, en el espacio epidural posterior torácico. Objetivo: Presentar un caso que debutó con un traumatismo axial lumbosacro donde se evidenció una localización poco común de la lesión y sin relación con las estructuras del canal raquídeo. Presentación del caso: Hombre de 25 años que se cayó y debido a ello se le hizo un traumatismo directo en la región sacrococcígea con dolor y aumento de volumen regional, asociado a parestesias glúteas. Los estudios radiológicos evidenciaron una fractura del cóccix y la presencia de una lesión ubicada en las partes blandas, de aspecto redondeado, homogéneo, sólido, de poco más de 50 mm de diámetro. Se le realizó tratamiento quirúrgico que consistió en coccigectomía subperióstica y exéresis macroscópica de la masa. El estudio histológico concluyó el diagnóstico de un angiolipoma. Conclusiones: Los angiolipomas son tumores raros que tienen características radiológicas peculiares, requieren de alta sospecha clínico-imagenológica para indicar los estudios y el tratamiento. La exéresis total es recomendada para evitar la recurrencia y mejorar el pronóstico.

Background: Angiolipomas are benign tumors that appear in adults with special location in the posterior thoracic epidural position. Objective: To present a case that appeared with a lumbosacral axial trauma where a non-common lesion location was evidenced with no relation among the structures of the spinal canal. Case presentation: 25-year-old man who fell down, consequently suffered a painful direct trauma to the sacrococcygeal region and increased regional volume, associated with gluteal paresthesias. Radiological studies showed a fracture of the coccyx and presence of a lesion located in the soft tissues, with a rounded, homogeneous, solid aspect, a little more than 50 mm in diameter. Surgical treatment consisted of subperiosteal coccygectomy and macroscopic excision of the mass. Histological study concluded the diagnosis of an angiolipoma. Conclusions: Angiolipomas are rare tumors with peculiar radiological features, they require high clinical-imaging suspicion for studies and treatment. Total excision is recommended to avoid recurrence and improve prognosis.

Morel-Lavallée Lesion in the Sacrococcygeal Area with Associated Coccygeal Fracture / 대한신경손상학회지

A Morel-Lavallée lesion is a posttraumatic, closed internal degloving injury caused by shearing force abruptly separating the skin and superficial fascia from the deep fascia and creating a potential space. Blood, lymphatic fluid, and debris collect and fill the space. The most commonly affected sites are the thigh, knee, hip, and pelvic area, but the lesion can occur anywhere in the body. Among various treatments, surgical procedure is a good option if the lesion is chronic and a thick peripheral capsule has developed. We report an uncommon case of a chronic Morel-Lavallée lesion in the sacrococcygeal area, a rarely reported location, with an associated coccygeal fracture and dislocation.

Single-center Experience of 24 Cases of Tailgut Cyst

PURPOSE: Tailgut cysts are rare congenital or developmental lesions that arise from vestiges of the embryological hindgut. They are usually present in the presacral space. We report our single-center experience with managing tailgut cysts. METHODS: We conducted a retrospective analysis of 24 patients with tailgut cyst treated surgically at the Colorectal Surgery Department of Severance Hospital, Yonsei University, Seoul, South Korea, between 2007–2018. RESULTS: This study included 24 patients (18 females) with a median age of 51.5 years (range, 21–68 years). Ten cases were symptomatic and 14 were asymptomatic. Cysts were retrorectal in 21 patients. Cysts were below the coccyx level in 16 patients, opposite the coccyx in 6, and above the coccyx in 2. Cysts were supralevator in 5 patients, had a supra- and infralevator extension in 18 patients, and were infralevator in 1. Ten patients were managed using an anterior laparoscopic approach, 11 using a posterior approach, and 3 using a combined approach. Mean cyst size was 5.5 ± 2.7 cm. Postoperative complications were Clavien-Dindo (CD) classification grade II in 9 patients (37.5%) and CD grade III in 1 (4.2%). The posterior approach group showed the highest rate of complications (P = 0.021). Patients managed using a combined approach showed a larger cyst size (P < 0.001), longer operation times (P < 0.001), and a greater likelihood of tumor level above the coccyx (P = 0.002) compared to other approaches. The tumors of 2 male patients were malignant: 1 was a neuroendocrine tumor treated with radiotherapy, while the other was a closely followed adenocarcinoma. Median follow-up was 12 months (range, 1–66 months) with no recurrence. CONCLUSION: Tailgut cysts are uncommon but can cause perineal or pelvic pain. Complete surgical excision via an appropriate approach according to tumor size, location, and correlation with adjacent pelvic floor muscles is the key treatment.

Hypomelanosis of Ito with Multiple Congenital Anomalies

Hypomelanosis of Ito (HI) is a neurocutaneous disorder, also known as incontinentia pigmenti achromians. HI has been associated with chromosomal abnormalities, especially mosaicism. Herein, we report a case of HI with multiple congenital anomalies. A 2-month-old girl presented with multiple linear and whorling hypopigmentation on the face, trunk, and both extremities and patch alopecia on the scalp. Moreover, she had conical teeth, aniridia of the both eyes, and multiple musculoskeletal problems, including syndactyly and coccyx deviation. Cytogenetic analysis on peripheral blood was normal 46, XX, and no mutation was found in IKBKG gene test.

Late-Onset Spinal Subdural Hematoma after Acupuncture

Acupuncture is generally regarded as a safe procedure and as a popular treatment for patients with musculoskeletal disorders. We report a case of a 47-year-old male patient with late-onset tetraplegia, developed after acupuncture. He had no trauma, medical, and social history relevant to tetraplegia. Right after the acupuncture, he felt discomfort in his right arm. After 6 days, all 4 extremity weakness developed. Whole-spine magnetic resonance imaging revealed the presence of spinal subdural hematoma extending from the C5 vertebra to the coccyx level. Hand coordination dysfunction, neurogenic bladder, and neuropathic pain were other symptoms. After the management, he recovered muscle strength, but incomplete bladder control and neuralgia were sustained. It is important to be aware of the possibilities of severe complications after acupuncture.

Terapia manual como tratamiento en pacientes con cocgigodinia / No disponible

Introducción: La coccidinia o coccigodinia fue descrita como un dolor que surge alrededor del coxis que puede irradiarse al ano, genitales y piernas, agravándose con la defecación y las relaciones sexuales. El dolor crónico en el ano, recto u otros órganos pélvicos, se presenta entre el 7% y el 24% de la población, asociándose con problemas de calidad de vida. La coccigodinia constituye menos del 1% de las consultas no traumáticas de dolencias vertebrales. Objetivo: Realizar una revisión sistemática sobre el tratamiento a través de la terapia manual en pacientes con coccigodinia. Material y Métodos: Se utilizan las bases de datos Pubmed, PEDro, Biblioteca Cochrane Plus, Scielo, LILACS, ENFISPO y ScienceDirect, empleando las palabras clave Coccyx; Coccydynia; Coccygodynia, "Physical Therapy Modalities"; "Manual Therapy"; Osteopath; Manipulati; Physiotherap y Treatment. Se incluyen ensayos clínicos publicados entre enero de 2000 y mayo de 2017, escritos en castellano, inglés, francés, italiano y portugués. Se excluyen artículos que no utilicen la terapia manual como tratamiento para la coccigodinia y los estudios sobre pacientes menores de 18 años. Resultados: Se seleccionan, siguiendo los criterios de inclusión/exclusión, 6 artículos para la presente revisión. Incluyen documentación sobre los tratamientos de terapia manual para abordar la coccigodinia, así como distintas maniobras de tratamiento. Conclusiones: La terapia manual como método para abordar la coccigodinia puede ser un tratamiento sencillo y efectivo para disminuir la sensación de dolor en estos pacientes. Las técnicas de tratamiento más empleadas son las manipulaciones intrarectales. Se necesita más cantidad de estudios de alta calidad metodológica para estudiar la efectividad de estas técnicas

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Ultrasonographic features of the normal filum terminale

PURPOSE: The filum terminale (FT) is a fibrous band that connects the conus medullaris to the posterior body of the coccyx. Considering the advances of ultrasonography (US) technology and improvements in the resolution of US images, we aimed to re-establish the US features of the normal FT in infants younger than 6 months of age. METHODS: We retrospectively reviewed 30 spinal US scans, stored as video clips. The internal structure of the FT and the marginal echogenicity of the FT were assessed, and transverse and longitudinal US were compared. RESULTS: On US, a central echogenic line was defined in 18 (60%) normal FTs; however, there was no visible internal structure in 12 cases (40%). The marginal echogenicity of the FT was hyperechoic in eight cases (27%) in comparison with the cauda equina and was isoechoic in 22 cases (73%). In differentiating the normal FT from the surrounding nerve roots, transverse US was superior in 18 cases (60%), while longitudinal US was superior in two cases (7%). CONCLUSION: On US, the central canal of the FT was defined in 60% of normal FTs. Hyperechoic marginal echogenicity and the use of transverse US were helpful in distinguishing the normal FT from the nerve roots of the cauda equina.

Structural damage to the hip in systemic juvenile idiopathic arthritis: a case of regression with Anakinra / Daño estructural de la cadera en la artritis idiopática juvenil sistémica: un caso de regresión con Anakinra

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Coccigodinia relacionada con uso de anillo vaginal anticonceptivo / Coccydynia related to the use of a contraceptive vaginal ring

La coccigodinia es un síndrome que se presenta con frecuencia en las consultas de Reumatología en forma de dolor en punta terminal del coxis, empeorando habitualmente al sentarse. Aunque la causa más frecuente es la postraumática local, existen diversas causas de dolor en el coxis. Presentamos un caso inhabitual en el que la coccigodinia comenzó poco después de instaurar un sistema de anticoncepción por anillo vaginal y remitió completamente al retirar este sistema (AU)

Coccydynia is a syndrome that rheumatologists encounter frequently in the form of tailbone pain, which is usually worse when sitting. Although the most common origin is trauma, there are several other possible causes of pain in the coccyx. We present an unusual case in which coccydynia developed shortly after the insertion of a contraceptive vaginal ring and remitted completely upon removal of this system (AU)

Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India

STUDY DESIGN: A retrospective, cross-sectional study of 213 patients who presented for abdominal computed tomography (CT) scans to assess coccygeal morphology in the Indian population. PURPOSE: There have been relatively few studies of coccygeal morphology in the normal population and none in the Indian population. We aimed to estimate coccygeal morphometric parameters in the Indian population. OVERVIEW OF LITERATURE: Coccygeal morphology has been studied in European, American, Korean, and Egyptian populations, with few differences in morphology among populations. METHODS: A retrospective analysis of 213 abdominal CT scans (114 males and 99 females; age, 7–88 years; mean age, 47.3 years) was performed to evaluate the number of coccygeal segments, coccyx type, sacrococcygeal and intercoccygeal fusion and subluxation, coccygeal spicules, sacrococcygeal straight length, and sacrococcygeal and intercoccygeal curvature angles. Results were analyzed for differences in morphology with respect to sex and coccyx type. RESULTS: Types I and II coccyx were the most common. Most subjects had four coccygeal vertebrae; 93 subjects (43.66%) had partial or complete sacrococcygeal fusion. Intercoccygeal fusion was common, occurring in 193 subjects. Eighteen subjects had coccygeal spicules. The mean coccygeal straight length was 33.8 mm in males and 31.5 mm in females; the mean sacrococcygeal curvature angle was 116.6° in males and 111.6° in females; the mean intercoccygeal curvature angle was 140.94° in males and 145.10° in females. CONCLUSIONS: Type I was the most common coccyx type in our study, as in Egyptian and Western populations. The number of coccygeal vertebrae and prevalence of sacrococcygeal and intercoccygeal fusion in the Indian population were similar to those in the Western population. The mean coccygeal straight length and mean sacrococcygeal curvature angle were higher in males, whereas the intercoccygeal curvature angle was higher in females. Information on similarities and differences in coccygeal morphology between different ethnic populations could be useful in imaging and treating patients presenting with coccydynia.

A Nation-Wide Epidemiological Study of Newly Diagnosed Primary Spine Tumor in the Adult Korean Population, 2009–2011

OBJECTIVE: This 2009–2011 nation-wide study of adult Koreans was aimed to provide characteristics, medical utilization states, and survival rates for newly diagnosed patients with primary nonmalignant and malignant spine tumors. METHODS: Data for patients with primary spine tumors were selected from the Korean Health Insurance Review and Assessment Service database. The data included their age, sex, health insurance type, co-morbidities, medical cost, and hospital stay duration. Hospital stay duration and medical costs per person occurring in one calendar year were used. In addition, survival rates of patients with primary malignant spine tumors were evaluated. RESULTS: The incidence rate of a primary spine tumor increased with age, and the year of diagnosis (p≤0.0001). Average annual medical costs ranged from 1627 USD (pelvis & sacrum & coccyx tumors) to 6601 USD (spinal cord tumor) for primary nonmalignant spine tumor and from 12137 USD (spinal meningomas) to 20825 USD (pelvis & sacrum & coccyx tumors) for a primary malignant spine tumor. Overall survival rates for those with a primary malignant spine tumor were 87.0%, 75.3%, and 70.6% at 3, 12, and 24 months, respectively. The Cox regression model results showed that male sex, medicare insurance were significantly positive factors affecting survival after a diagnosis of primary malignant spine tumor. CONCLUSION: Our study provides a detailed view of the characteristics, medical utilization states, and survival rates of patients newly diagnosed with primary spine tumors in Korea.