Introduction: Coccyx pain is very common in patients with abnormalities of the sacro-coccygeal junction, either due to congenital hyperangulation, injury-related dislocation, fracture, degeneration or pregnancy.
Methods: 18 consecutive patients, presenting with variable periods of coccydynia, were examined. They all had long durations of coccydynia, often along with sacro-iliac pain and/or sciatica. X-rays, MRI of C-spine and laboratory investigations were performed in all of those patients.
The patients were offered a combination of analgesia, anti-inflammatory, physiotherapy, regular lumbar and pelvic extension exercises and correction of their low levels of vitamin D levels and daily oral calcium over a period of 6 weeks.
Those 18 patients, selected for this study, were those who did not respond to the conservative regimen. Those patients had up to 3 sessions of steroid injections into the ganglion impar. In case of non-response or partial response, 1 to 3 ml of absolute ethanol was injected into the ganglion impar. The patients were followed-up for periods of up to 3-12 months.
Results: The majority of the patients were females with below 40 years of age. They all presented with coccydynia. The imaging of their sacro-coccygeal spine showed kyphosis with disc degeneration in the sacro-coccygeal region.
After one steroid injection only, the 16 out of those 18 patients did fully (9) or partially respond (7). In case of full response, the treatment plan was finished. In case of partial response, the patients underwent a second session. After 3 sessions, one patient remained with partial response, and was subsequently injected with ethanol, which finally resulted in a full response also in this patient.
There was significant improvement of their symptoms using the above mentioned treatment strategy and with ganglion impar injections.
Conclusions: However, independent of the etiology, injection to block the signals of that ganglion impar may provide significant long term pain relief to the patient with coccyx pain. The multidisciplinary approach may preserve the patient from coccygectomy in most of the cases.
Patient Care: It will enhance the outcomes of treatment in patients suffering from this condition.
Learning Objectives: Good understanding of the etiology and treatment modalities of coccyx pain can result in good clinical outcomes in this common condition that is often treated inadequately.