14. Coccygodynia

Abstract

Coccygodynia is painful condition localized in the region of the coccyx. In most cases a traumatic etiology is present. In the idiopathic form other causes such as infections and tumor have to be excluded. Coccygodynia can also be the result of pain referred from visceral structures due to conditions such as disorders of the rectum, the colon sigmoideum, and the urogenital system. In case of a traumatic etiology the diagnosis is made based on the typical medical history whereby the pain is provoked by prolonged sitting and cycling. Lateral images of the coccyx are always indicated. The same is true for manual examination of the coccyx. In case of absence of provocation of the coccygeal pain by prolonged sitting and manual examination neurological causes such as lumbar disc hernias are a possible reason for the coccygodynia. In the acute phase the first choice of treatment are NSAIDs. Treatment for patients with severe pain in the chronic phase consists of manual therapy and/or a local injection of local anesthetic and corticosteroid into the painful segment (2 C+). Other interventional treatments such as intradiscal injections, ganglion impar block, radiofrequency treatment and caudal block are advised only under study conditions (0). Coccygectomy is not recommended because of long-term moderate results and the chance of major complications.

Morphometric Study of the Normal Egyptian Coccyx from (Age 1-40 Year)

“…This difference is highly significant. These obtained results were in agreement with (18), (19) they all found that Lateral deviation of the coccyx is increased steadily with age and always greater in male groups than female groups. However, (19), (20) found that In fourth age group(20-40 years) of European individuals the Lateral deviation of the coccyx in male is 15.7°± 12.1° , while in female is 14.1° ± 11°.…”

Clinical Decision Making for the Evaluation and Management of Coccydynia: 2 Case Reports

“…Coccygectomy, or surgical extraction of the coccyx, has been recommended in cases of acute trauma, including unstable fractures or recalcitrant pain, when conservative management has been deemed unsuccessful or has not provided sufficient relief. 1,3,6,[13][14][15][16][17] In a retrospective analysis of 32 individuals treated by an orthopaedic spine surgeon over a 5-year period, Hodges et al 5 reported that 13% of the patients were treated with nonsteroidal anti-inflammatory drugs alone, 53% were treated with both nonsteroidal anti-inflammatory drugs and local injections, and 34% underwent coccygectomy. In their study, those who underwent coccygectomy had significantly greater pain scores and slightly greater Oswestry Disability Index scores pretreatment than those who were treated conservatively.…”

Nuevo concepto de unidad funcional lumbo-sacro-coccígea-pélvica. Bases teóricas y repercusión en el análisis clínico y terapéutico de los pacientes con dolor lumbar

“…El cóccix es una estructura ósea compuesta por 4 segmentos, los cuales están unidos entre sí por articulaciones no móviles (sinartrosis) y al sacro por un disco intervertebral rudimentario que permite su movilidad en el plano sagital (30). Embriológicamente, es el remanente de la cola embrionaria, evidente en la mayoría de los mamíferos pero que en seres humanos regresa dejando una estructura ósea (cóccix), un músculo isquiococcígeo y el ligamento sacroespinoso como vestigio.…”

“…Cuando se hace crónico aparecen espículas óseas, deformidad y dolor. El síntoma doloroso es transmitido por el plexo simpático pélvico, los ganglios prevertebrales y el plexo coccígeo propio (ganglio impar de Walther) (30,32). La percepción dolorosa desde la región perineal y sacro-coccígea se caracteriza por ser una sensación difusa irradiada a la porción inferior de la región lumbar por comunicaciones interfasciculares del plexo sacro dorsal.…”