Transsacrococcygeal approach to ganglion impar: radiofrequency application for the treatment of chronic intractable coccydynia

Abstract

ObjectiveCoccydynia is defined as pain in the coccygeal region. Among the many causes of coccydynia, the most common cause is trauma as a result of falling on the buttocks, repetitive microtrauma, or childbirth. Several methods are currently used for the treatment of coccydynia, including nonsteroidal anti-inflammatory drugs, intrarectal manipulation, epidural injections, ganglion impar blocks, and radiofrequency treatment (RFT). Wemm and Saberski used the transacrococcygeal methods to reduce tissue trauma. RFT is a percutaneous minimally invasive procedure. In this study, we aimed to assess the effect of the transsacrococcygeal approach on ganglion impar RFT in patients with chronic coccydynia.MethodsWe retrospectively examined the data of 41 patients at the Department of Anesthesiology and Reanimation, Faculty of Medicine, Maltepe University (Pain Clinic), between January 1, 2010, and December 31, 2012.ResultsThe mean age of the patients was 46.68±11.00 years (range 28–67 [46] years). The average pain duration was 3.10±1.37 years. The difference between visual analog scale scores of the pre-and postprocedure was statistically significant. In the examinations carried out in the sixth month of the treatment, 90.2% of patients had a successful outcome, whereas treatment failed in 9.8% of patients. According to our patients’ data, most of them had pain due to a trauma, were female, and overweight. Visual analog scale difference between preprocedure and early postprocedure, preprocedure and first month, preprocedure and sixth month were statistically significant (P=0.001).ConclusionBased on the lower pain scores and low complication rates after the operations, the results suggest that application of RFT on ganglion impar by the transsacrococcygeal approach is an effective and safe method for the treatment of chronic coccydynia. Patient selection, technique, and experience are the most important factors affecting the success of this method.

Ganglion blocks as a treatment of pain: current perspectives

“…The examinations carried out in the sixth month of the treatment showed that 37 patients had a successful outcome, whereas treatment failed in four of the patients. 93 …”

Coccydynia Treated with Dorsal Root Ganglion Stimulation

“…Injections around the coccyx, usually at the sacrococcygeal junction or around the sacrococcygeal ligaments, of local anesthetic with steroid can be both diagnostic and therapeutic [ 9 ]. Another approach is to target the ganglion impar, also known as the ganglion of Walther [ 10 ]. The ganglion impar is the pelvic portion of the sympathetic trunk located in the midline anterior to the sacrococcygeal junction.…”

Ganglion Impar Radiofrequency Ablation For Intractable Cancer Pain: A Case Report

“…Dolecek et al 4 described 18 patients treated with RF reported a satisfactory pain relief in 57% of patients at 12 months follow up while Demircay et al 8 reported a good pain relief lasting for 6 months in 90% of 10 patients treated with RF. Adas et al 9 described 41 patients treated with RF for coccydynia and reported a successful outcome at 6 months follow up in 90.2% of patients. 9 Even if only few studies investigated RF ablation, this technique seems to provide comparable results as chemical neurolysis.…”

“…Adas et al 9 described 41 patients treated with RF for coccydynia and reported a successful outcome at 6 months follow up in 90.2% of patients. 9 Even if only few studies investigated RF ablation, this technique seems to provide comparable results as chemical neurolysis. The small number of studies and population studied prevents from getting precise data regarding the magnitude and frequency of adverse events with both RF and neurolysis which appears to be relatively safe.…”

“…1 Ganglion impar neurolysis is a well documented technique to reduce pain arising from perineal visceral structures such as rectum and anus. [1][2][3][4][5][6][7][8][9][10] Sensitive C and Aδ afferent fibers run from visceral structures to the spinal ganglia where the neuron body is located and they run together with the sympathetic fibers innervating splanchnic organs. 9 Afferent sensitive fibers cross the sympathetic ganglia without synapsing in it, therefore, lesioning the sympathetic chain could result in a reduction of pain transmitted through these somatic fibers.…”