Scott D Hodges1, Jason C Eck, S Craig Humphreys. 1. Center for Sports Medicine and Orthopaedics, Foundation for Research, 2415 McCallie Avenue, Chattanooga, TN 37404, USA.
Abstract
BACKGROUND CONTEXT: Coccydynia is a painful condition of the terminal portion of the spine often resulting from direct trauma, childbirth or unknown etiology. This is a relatively rare condition with no universally accepted treatment protocol. PURPOSE: To more clearly determine the optimal treatment for patients with coccydynia and to assess the outcomes after conservative and surgical therapy. STUDY DESIGN: Retrospective review of outcomes of all patients presenting with symptoms of coccydynia during a 5-year period. PATIENT SAMPLE: Thirty-two patients presented to an orthopedic spine surgeon during a 5-year period with symptoms of coccydynia. OUTCOME MEASURES: Patients completed visual analog pain scales (VAS) and the Oswestry (OSW) functional capacity index. METHODS: Of the 32 patients in the study, 4 (13%) were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone, 17 (53%) were treated with NSAIDs followed by local injections and 11 (34%) underwent coccygectomy after failure of NSAIDs and local injections. Patients completed VAS and OSW forms. Pain drawings were also completed. RESULTS: Patients undergoing surgery had significantly greater pretreatment VAS scores (8.3 vs 5.4, p=.002). Surgical patients also had greater OSW scores, but not significantly (36.6 vs 24.2, p=.223). Marked improvement was reported by 9 of 11 (82%) surgical patients. Three of 11 (27%) surgical patients developed wound infections and 1 (9%) wound dehiscence. All infections resolved following irrigation and debridement and a short course of oral antibiotics. CONCLUSIONS: Patients with coccydynia should be managed conservatively when possible. Treatment should include NSAIDs and local steroid injections. Patients will often require repeat injections over time. Surgery can offer reasonable results for patients failing conservative treatment, but they should be warned of the high rate of infection.
BACKGROUND CONTEXT: Coccydynia is a painful condition of the terminal portion of the spine often resulting from direct trauma, childbirth or unknown etiology. This is a relatively rare condition with no universally accepted treatment protocol. PURPOSE: To more clearly determine the optimal treatment for patients with coccydynia and to assess the outcomes after conservative and surgical therapy. STUDY DESIGN: Retrospective review of outcomes of all patients presenting with symptoms of coccydynia during a 5-year period. PATIENT SAMPLE: Thirty-two patients presented to an orthopedic spine surgeon during a 5-year period with symptoms of coccydynia. OUTCOME MEASURES: Patients completed visual analog pain scales (VAS) and the Oswestry (OSW) functional capacity index. METHODS: Of the 32 patients in the study, 4 (13%) were treated with nonsteroidal anti-inflammatory drugs (NSAIDs) alone, 17 (53%) were treated with NSAIDs followed by local injections and 11 (34%) underwent coccygectomy after failure of NSAIDs and local injections. Patients completed VAS and OSW forms. Pain drawings were also completed. RESULTS:Patients undergoing surgery had significantly greater pretreatment VAS scores (8.3 vs 5.4, p=.002). Surgical patients also had greater OSW scores, but not significantly (36.6 vs 24.2, p=.223). Marked improvement was reported by 9 of 11 (82%) surgical patients. Three of 11 (27%) surgical patients developed wound infections and 1 (9%) wound dehiscence. All infections resolved following irrigation and debridement and a short course of oral antibiotics. CONCLUSIONS:Patients with coccydynia should be managed conservatively when possible. Treatment should include NSAIDs and local steroid injections. Patients will often require repeat injections over time. Surgery can offer reasonable results for patients failing conservative treatment, but they should be warned of the high rate of infection.