1. Surgical management of coccygeal pain
Hazem Akil, MD,MRCSEd
Macquarie Neurosurgery
Evidence Based Surgery presentation
August 2012
EBS presentation

2. Clinical case
• 57 year old female
• Fall on her bottom 1.5 year ago
• Pain in the coccygeal area, exacerbated by sitting, straining, coitus
• MRI showed acute angulation of the coccyx
• Bone scan did not show increased uptake
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3. Clinical case
• Underwent u/s guided injection with temporary relief of
pain for one day
• Offered surgery afterwards
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4. Clinical question
• Is surgery effective in treatment of refractory coccydynia?
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5. Searchable question (PICO format)
• P: Patients with coccygeal pain
• I: Surgery
• C:
• O: Pain relief
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6. Search strategy
• MEDLINE
• EMBASE
• SCOPUS
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7. Coccygeal pain Coccydynia Coccygodynia
*
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8. Coccygeal pain Coccydynia Coccygodynia
*Coccyx/ Coccy*
Focused subject heading Truncated Keyword
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9. EBS presentation

10. *Coccyx/ Pain
64
Limit to english language/Humans
42
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11. EBS presentation

12. EBS presentation

13. Limit to english language/Humans
42
Therapy (Max. Sensitivity)
8
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14. *Coccyx/ Pain
64
Limit to english language/Humans
42
Therapy (Max. Sensitivity)
8
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15. Coccy* Pain Surg*
83
Limit to english language and humans
58
Final choice
20
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16. EBS presentation

17. EBS presentation

18. EBS presentation

19. English language and Humans
150
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20. Author(s) Year Type No of pts Outcome (+)
Karadimas et al 2011 review 671 85%
Kerr et al 2011 retrospective 26 84.6%
Biligic et al 2010 retrospective 25 84%
Cheng et al 2011 ? 31 87.1%
Cabesoy et al 2007 retrospective 21 100%
Sehirlioglu et al 2007 retrospective 74 71 has positive results
Balain et al 2006 case series 31 71%
88% (traumatic)
Pennekamp et al 2005 retrospective 16
38% (idiopathic)
Kirkham et al 2004 retrospective 20 90%
Trollegaard et al 2010 retrospective 39 33 pts
Traub et al 2009 retrospective 8 87.5%

21. Author(s) Year Type No of pts Outcome (+)
Postacchini et al 1983 retrospective 51 88%
Bayne et al 1984 retrospective 48 60%
Eng et al 1988 retrospective 27 67%
Hellberg et al 1990 retrospective 65 86%
Maigne et al 2000 prospective 37 92%
Perkins et al 2003 retrospective 13 54%
Doursounian et al 2004 retrospective 61 87%
Mouhsine et al 2006 retrospective 15 93%

22. Author(s) Year Type No of pts Outcome (+)
Gaspar et al 2009 retrospective 34 82%
Feldbrin et al 2005 retrospective 9 6
Karalezli et al 2004 retrospective 14 12
Hodges et al 2004 retrospective 11 82%
Ramsey et al 2003 retrospective 15 87%
Grosso et al 1995 retrospective 9 100%
Wray et al 1991 prospective 23 21
Wray et al 1982 retrospective 37 33

23. Conclusions
• Surgery is very effective in treating refractory coccydynia
• All papers looked at surgery following reasonable time of
conservative/non-surgical management
• Consideration of complications (infection)
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24. Thank you
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