Solène Charrière1, Jean-Yves Maigne1, Emmanuel Couzi1, Marie-Martine Lefèvre-Colau1,2,3,4, François Rannou1,2,5, Christelle Nguyen6,7,8. 1. Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. 2. Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France. 3. Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire Et Biomarqueurs (T3S), INSERM UMR-S 1124, Campus Saint-Germain-des-Prés, 75006, Paris, France. 4. Institut Fédératif de Recherche Sur Le Handicap, 75013, Paris, France. 5. Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, INSERM UMR-S 1153, 75004, Paris, France. 6. Hôpital Cochin, Service de Rééducation Et de Réadaptation de L'Appareil Locomoteur et des Pathologies du Rachis, AP-HP. Centre-Université de Paris, 27, Rue du Faubourg Saint-Jacques, 75014, Paris, France. christelle.nguyen2@aphp.fr. 7. Faculté de Santé, UFR de Médecine, Université de Paris, 75006, Paris, France. christelle.nguyen2@aphp.fr. 8. Centre de Recherche Épidémiologie Et Statistique Paris (CRESS), ECaMO Team, INSERM UMR-S 1153, 75004, Paris, France. christelle.nguyen2@aphp.fr.
Abstract
PURPOSE: To describe long-term outcomes of conservative treatment for chronic coccydynia. METHODS: We conducted a 36-month prospective observational study. Adults with chronic coccydynia (> 2 months) were included. The first-line treatment was coccygeal corticosteroid injection. The second-line treatment was either manual therapy or coccygectomy. The primary endpoint was the mean variation from baseline of coccydynia intensity at 6 and 36 months, using a numeric rating scale (0, no pain; 10, maximal pain). Evolution was considered unfavorable when coccydynia intensity was > 3 of 10 points at 36 months or coccygectomy had been performed. We carried out bivariate and multivariate analyses to identify variables associated with an unfavorable evolution. RESULTS: We included 115 participants. Mean (SD) age was 43.5 (12.3) years, duration of coccydynia 18.4 (21.6) months and coccydynia intensity 6.5 (2.0) of 10 points. Mean variations for coccydynia intensity were - 1.5 (3.0) at 6 months and - 2.8 (3.2) at 36 months. At 36 months, 59/115 (51%) participants had an unfavorable evolution. In bivariate analysis, posterior coccyx dislocations were numerically more frequent in participants with an unfavorable evolution compared to others (29/59 (48%) versus 17/56 (30%), p = 0.057). In multivariate analysis, longer duration of coccydynia was associated with an unfavorable evolution (OR = 1.04, 95% CI from 1.01 to 1.07, p = 0.023). CONCLUSION: In adults with chronic coccydynia receiving conservative treatment, symptoms decrease overtime, but significantly persist at 36 months in more than half of them. For patients with posterior coccyx dislocation, coccygectomy may be considered rapidly.
PURPOSE: To describe long-term outcomes of conservative treatment for chronic coccydynia. METHODS: We conducted a 36-month prospective observational study. Adults with chronic coccydynia (> 2 months) were included. The first-line treatment was coccygeal corticosteroid injection. The second-line treatment was either manual therapy or coccygectomy. The primary endpoint was the mean variation from baseline of coccydynia intensity at 6 and 36 months, using a numeric rating scale (0, no pain; 10, maximal pain). Evolution was considered unfavorable when coccydynia intensity was > 3 of 10 points at 36 months or coccygectomy had been performed. We carried out bivariate and multivariate analyses to identify variables associated with an unfavorable evolution. RESULTS: We included 115 participants. Mean (SD) age was 43.5 (12.3) years, duration of coccydynia 18.4 (21.6) months and coccydynia intensity 6.5 (2.0) of 10 points. Mean variations for coccydynia intensity were - 1.5 (3.0) at 6 months and - 2.8 (3.2) at 36 months. At 36 months, 59/115 (51%) participants had an unfavorable evolution. In bivariate analysis, posterior coccyx dislocations were numerically more frequent in participants with an unfavorable evolution compared to others (29/59 (48%) versus 17/56 (30%), p = 0.057). In multivariate analysis, longer duration of coccydynia was associated with an unfavorable evolution (OR = 1.04, 95% CI from 1.01 to 1.07, p = 0.023). CONCLUSION: In adults with chronic coccydynia receiving conservative treatment, symptoms decrease overtime, but significantly persist at 36 months in more than half of them. For patients with posterior coccyx dislocation, coccygectomy may be considered rapidly.
Entities:
Keywords:
Chronic back pain; Coccydynia; Prospective observational study
Authors: John P Kleimeyer; Kirkham B Wood; Greger Lønne; Tyler Herzog; Kevin Ju; Lisa Beyer; Christine Park Journal: Spine (Phila Pa 1976) Date: 2017-08-15 Impact factor: 3.468