COCCYGEOPLASTY: AN EXPLORATION OF A NOVEL APPROACH FOR TREATING RESISTANT COCCYDYNIA IN PATIENTS WITH COCCYGEAL HYPERMOBILITY

L. Manfrè¹ , I. Gil² , T. Baptista³ , P. Calvão Pires⁴ , A.E. De Vivo¹, S. Masala⁵, R.V. Chandra⁶ , G. D'Anna⁷ , J. Hirsch⁸ , M. Frigerio⁹, M. Bonetti⁹

¹ Department of Radiology, IOM Mediterranean Oncology Institute, Viagrande, Sicily, Italy
² Department of Neuroradiology, Centro Hospitalar do Algarve EPE, Faro, Portugal
³ Department of Neuroradiology, Oxford University Hospitals NHS Trust, Oxford, UK
⁴ Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
⁵ Department of Diagnosis Imaging Interventional Radiology and Clinical Pathology, Ospedale San Giovanni Battista, Roma, Italy
⁶ Department of Interventional Neuroradiology, Monash Health, Clayton, Victoria, Australia
⁷ Department of Radiology, IRCCS Istituto Clinico Humanitas, Rozzano, Italy
⁸ NeuroEndovascular Program, Massachusetts General Hospital, Boston, Massachusetts, USA
⁹ Department of Neuroradiology, City of Brescia Clinical Institute, Brescia, Italy

Correspondence to:

Journal of Orthopedics 2024 January-April; 16(1): 1-8

Received: 23 March 2024 Accepted: 18 April 2024

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Abstract

Coccydynia can be attributed to various factors, including fractures, subluxations, and hypermobility within the sacrococcygeal area. Current treatment options often fall short in effectiveness. Coccygeoplasty (CP) represents a relatively recent, minimally invasive approach that aims to tackle this challenging clinical issue. The aim of this study is to evaluate clinical outcomes immediately following the procedure and at 3- and 12-month follow-ups for patients suffering from coccydynia linked to coccygeal hypermobility and subluxation. Furthermore, we seek to assess any correlations between imaging results and clinical outcomes at the follow-up intervals. A prospectively maintained database was used to retrospectively assess all patients who received CP for chronic coccydynia from January 2005 until December 2023. Each participant exhibited painful hypermobility (greater than 25°) with anterior flexion verified through radiological assessments. Alternative coccydynia causes were ruled out using CT and MRI imaging techniques. Procedures were conducted under local anesthesia with a combination of fluoroscopic and CT guidance. Clinical assessments were performed at 3- and 12-months post-treatment utilizing the Visual Analogue Scale (VAS). A total of 19 patients underwent treatment at a single center. There were no complications linked to the procedures. At both the 3- and 12-months post-treatment, 75% of patients reported substantial reduction in VAS scores compared to baseline, with average reductions of 3.5 and 4.9, respectively. No instances of pain recurrence were noted at the 12-month follow-up, although one patient did not experience any pain alleviation. Post-treatment CT scans confirmed the fusion of sacrococcygeal segments in 14 patients, yet no significant correlation was identified between the imaging outcomes and clinical results (p=0.1). Patients suffering from chronic coccygeal pain due to subluxation and hypermobility exhibited positive clinical outcomes following CP, as evidenced at both the 3- and 12-month evaluations. Additional research is warranted to validate this technique further and identify factors that predict treatment success. Coccygeoplasty may serve as a viable alternative to coccygectomy.

Keywords: coccydynia, coccyx, fractures, hypermobility, pain, subluxations