MANAGEMENT OF IDIOPATHIC COCCYDYNIA

Abstract

Introduction: The purpose of this study, performed prospectively, was to determine the effectiveness of 2-staged treatment protocol in idiopathic coccydynia in whom conservative treatment methods had failed.
Patients and methods: Twenty patients underwent a 2-staged treatment protocol in a fiveyear prospective trial. Conservative treatment modalities was attempted but failed in all. The coccyx was manipulated one or two times and the coccygeal region was infiltrated with corticosteroids and local anaesthesia. The pain was unrelieved with this treatment in 6 patients and coccygectomy was performed. The results were evaluated according to the extent of pain relief on 100 mm visual analogue scale at the latest follow-up.
Results: The results were rated by the patient as excellent or good in 14 (70%) who got manipulation and injection as a first line procedure. Of the 6 patients, who underwent surgical excision, all had excellent results with complete relief of pain. Objective measurement of pain before and after the traetment methods showed statistically significant improvement in both treatment groups.
Discussion: Coccydynia is a symptom and defined as pain in and around the coccyx. The majority of cases respond well to conservative methods, such as nonsteroidal anti-inflammatory medication, alteration in sitting position, physiotherapy and local corticosteroid injection. If conservative treatment fails, consideration should be given to manipulation or surgical excision of the coccyx. Manipulation and local infiltration was successful in 70% of our patients. If the patient was still in pain despite to this treatment, coccygectomy was performed with even more successs rate. According to our results, we propose 2-staged treatment protocol in patients with idiopathic coccydynia who failed to respond conservative treatment.