Morphological Features of the Coccyx in the Turkish Population and Interrelationships Among the Parameters: A Computerized Tomography-Based Analysis

Abstract

Introduction The coccyx is well-known to be a highly variable structure considering its morphology. To our knowledge, the relationship between the coccygeal types and other morphological features has not been studied yet. In addition to the interrelations among morphological parameters, this study investigated the morphology and morphometry of coccyx more extensively in the adult Turkish population using computerized tomography images. Methods Five hundred subjects who underwent pelvic computerized tomography were included in this study. In addition to coccyx type and the counts of coccygeal vertebrae and segments, the presence of coccygeal deviation, sacrococcygeal joint (SCJ) fusion, SCJ subluxation, intercoccygeal joint (ICJ) fusion, and coccygeal spicule were evaluated. The coccygeal length, sacrococcygeal angle, and intercoccygeal angle were measured on the digital workstation. The findings were subjected to statistical analyses. Results The coccygeal vertebra count ranged between three to five, with an average of 4.04 ± 0.48. The range of coccygeal segment count was between one and five, with an average of 2.53 ± 1.02. ICJ fusion in any segment, SCJ fusion, and SCJ subluxation were identified in 397 subjects (79.4%), 343 subjects (68.6%), and 17 subjects (3.4%), respectively. The coccyx types from the most common to the least common were as follows: type 2, type 1, type 3, type 4, and type 5. Coccygeal deviation to the left side was observed in 71 subjects (14.2%), while coccygeal deviation to the right side was observed in 61 subjects (12.2%). A coccygeal spicule was identified in 73 subjects (14.6%). The subjects’ mean age demonstrated no significant difference considering the ICJ fusion (p=0.271), SCJ subluxation (p=0.51), coccygeal spicule (p=0.337), features of coccygeal deviation (p=0.83), and coccyx types (p=0.11). The subjects with SCJ fusion (50.7 ± 18.3 years) were significantly older than the subjects without SCJ fusion (46.5 ± 18.5 years) (p=0.016). The differences between the coccyx types considering the rate of SCJ fusion (p=0.002), ICJ fusion (p=0.04), and spicule presence (p<0.001) as well as the coccygeal vertebra count (p<0.001) were significant. Conclusion The presence of coccygeal spicule, a risk factor for coccydynia, is reported to be 14.6% in this study group that represents the Turkish population. This study indicates an association between the coccyx types and the frequency of SCJ fusion, ICJ fusion, and spicule presence and consequently suggests the significance of the coccyx type among the morphological features to cause susceptibility to coccydynia. Due to the multiplicity of the pain generators in the coccygeal region that is established by previous reports, the comparisons of different human populations and the knowledge on the interrelations between the morphologic parameters might facilitate the comprehension of the etiology of coccydynia. The clarification of interrelationship existence among ...

Imaging findings and treatment in coccydynia – update of the recent study findings

“…Coccygeal spicule, which is a risk factor for coccydynia, was reported in 14.6 % of cases. Significant differences were found between SCJ and ICJ effusions according to coccyx type and the number of coccyx vertebrae [24]. Yagi et al compared three-dimensional CT data of the coccyx in standing and supine positions.…”

Sağlık Bilimlerinde Akademik Analiz ve Tartışmalar

“…Kadınlarda koksiks morfolojisine bakıldığında düz, retrovert kısa olarak izlenir. Bir çalışmada sakrokoksigeal eklem füzyonu %68,6, interkoksigeal eklem füzyonu %79,4 olarak bildirilmiştir (Guneri & Gungor, 2021). Normalde sırt üstü poziyonda çekilen bilgisayarlı tomografi bir çalışmada ayakta yapılmış ve koksiksin 3 boyutlu verileri ortaya konmuştur.…”

Erişkinlerde koksiksin bilgisayarlı tomografi ile morfolojik ve morfometrik değerlendirilmesi

“…Kerimoğlu ve arkadaşlarının yaptığı 92 bireyden oluşan başka bir seride de çalışmamızla benzer şekilde en sık Tip 1, ikinci sıklıkta Tip 2 koksiks mevcuttu (11). Bu sonuçlardan farklı olarak Güneri ve Güngör'ün 500 hastalık serilerinde Türkiye popülasyonunda en sık Tip 2 (%69,6), ikinci sıklıkta Tip 1 (%12,6) ve yakın oranda Tip 3 koksiksi (%11) buldular (12). Genel olarak Türk, Arap ve Avrupalılarda en sık Tip 1 koksiks saptanmaktadır.…”

“…Güneri ve Güngör'ün araştırmasında ise beş segment (%13,4) koksiks sayısı ikinci sıklıkta saptanmıştır. Aynı çalışmada tek segment koksiks oranı %14,6 iken bizim çalışmamızda tek segment koksiks saptanmadı (12). Arap popülasyonunda (%68,3) ve Polonya popülasyonunda ise üç segment koksiks en sık saptanan koksiks tipidir (9,13).…”

“…Çalışmamızda koksiks segment sayıları ile yaş ve cinsiyet arasında ilişki literatür ile uyumlu şekilde ilişki saptanmadı (13,14). Ancak Türkiye popülasyonunda yapılmış bazı çalışmalarda kadınların ortalama segment sayılarının erkeklerden daha az olduğu bildirilmiş olsa da segment sayısı ile cinsiyet arasında direk bir ilişkilendirme henüz bildirilmemiştir (12,15). Cinsiyete dayalı koksigeal morfoloji ve morfometri değerlendirildiğinde bizim çalışmamızda erkeklerin sakral ve koksigeal dik ve eğimli uzunluklarının kadınlara göre daha fazla olduğunu saptadık.…”