Imaging Coccygeal Trauma and Coccydynia

Abstract

The coccygeal region has complex anatomy, much of which may contribute to or be the cause of coccyx region pain (coccydynia). This anatomy is well depicted at imaging, and management is often dictated by what structures are involved. Coccydynia is a common condition that is known to be difficult to evaluate and treat. However, imaging can aid in determining potential causes of pain to help guide management. Commonly, coccydynia (coccygodynia) occurs after trauma and appears with normal imaging features at static neutral radiography, but dynamic imaging with standing and seated lateral radiography may reveal pathologic coccygeal motion that is predictive of pain. In addition, several findings seen at cross-sectional imaging in patients with coccydynia can point to a source of pain that may be subtle and easily overlooked. Radiology can also offer a role in management of coccygeal region pain with image-guided pain management procedures such as ganglion impar block. In addition to mechanical coccyx pain, a host of other conditions involving the sacrococcygeal region may cause coccydynia, which are well depicted at imaging. These include neoplasm, infection, crystal deposition, and cystic formations such as pilonidal cyst. The authors review a variety of coccydynia causes, their respective imaging features, and common management strategies. ©

Sacrum magnetic resonance imaging for low back and tail bone pain: A quality initiative to evaluate and improve imaging utility

“…Sacrum MRI at our institution was overall found to be an inefficient method of diagnosis of low back or tailbone pain, not lending itself to cost effectiveness or significant impact on patient care. This further strengthens the argument that advanced imaging should be avoided in favor of conservative therapies in patients with vague low back pain without neurologic symptoms or other clinical red flags (such as recent trauma or malignancy)[ 7 , 8 ]. Physician education led to at least a short-term decrease in frequency of these orders by approximately 83%, effectively saving $24500 over a 3-mo time period.…”

“…In fact, increases in imaging in low back pain have been associated with increases in procedures for low back pain without improvement in outcomes—a finding highly suggestive of overutilization[ 4 , 5 ]. Coccydynia (or tail bone pain) has many similar underlying etiologies to low back pain, including muscular, post traumatic, and degenerative etiologies[ 6 , 7 ]. Treatment options also bear similarity to those available in patients with low back pain, including surgical and local therapeutic options based on the underlying pathology[ 6 , 8 ].…”

Coccydynia-A comprehensive review on etiology, radiological features and management options

“…Static imaging including radiographs, CT and MRI have been found to be inconclusive in a majority of patients with coccydynia. 23 Nevertheless, lateral and AP radiographs constitute an important primary investigation to rule out infections, tumors or predisposed coccygeal morphology such as retroverted coccyx, a bony spicule, coccygeal scoliosis or subluxation (Fig. 6).…”

“…Areas of T2 hyperintensity with low to intermediate T1 signals suggestive of Modic type 1 changes are commonly encountered in patients with chronic coccydynia, more so in patients with sub-luxation and hypermobility. 23 Balain et al demonstrated degenerative changes in histological samples of patients undergoing coccygectomy with signal alterations on MRI imaging. Additionally, MRI may also be able to diagnose chronic irritation and bursitis as edema on the tip of coccyx or soft tissue posteriorly.…”

Predictive factors affecting treatment success in ganglion impar block applied in chronic coccygodynia

“…However, no studies have examined the effects of individual sacrococcygeal anatomical differences evaluated by static radiography on treatment success. In the present research, the types of sacrococcygeal curvatures, permanent subluxation, and posterior bony spicule, which are risk factors for coccygodynia development, were evaluated radiographically 7 21. It was found that curvature types and the presence of posterior bony spicule had no effect on treatment success.…”