Ebs coccygeal pain 2012

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  • Ebs coccygeal pain 2012

    1. 1. Surgical management of coccygeal pain Hazem Akil, MD,MRCSEd Macquarie Neurosurgery Evidence Based Surgery presentation August 2012 EBS presentation
    2. 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 EBS presentation
    3. 3. Clinical case• Underwent u/s guided injection with temporary relief of pain for one day• Offered surgery afterwards EBS presentation
    4. 4. Clinical question• Is surgery effective in treatment of refractory coccydynia? EBS presentation
    5. 5. Searchable question (PICO format)• P: Patients with coccygeal pain• I: Surgery• C:• O: Pain relief EBS presentation
    6. 6. Search strategy• MEDLINE• EMBASE• SCOPUS EBS presentation
    7. 7. Coccygeal pain Coccydynia Coccygodynia * EBS presentation
    8. 8. Coccygeal pain Coccydynia Coccygodynia *Coccyx/ Coccy* Focused subject heading Truncated Keyword EBS presentation
    9. 9. EBS presentation
    10. 10. *Coccyx/ Pain 64 Limit to english language/Humans 42 EBS presentation
    11. 11. EBS presentation
    12. 12. EBS presentation
    13. 13. Limit to english language/Humans 42 Therapy (Max. Sensitivity) 8 EBS presentation
    14. 14. *Coccyx/ Pain 64 Limit to english language/Humans 42 Therapy (Max. Sensitivity) 8 EBS presentation
    15. 15. Coccy* Pain Surg* 83 Limit to english language and humans 58 Final choice 20 EBS presentation
    16. 16. EBS presentation
    17. 17. EBS presentation
    18. 18. EBS presentation
    19. 19. English language and Humans 150 EBS presentation
    20. 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. 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. 22. Author(s) Year Type No of pts Outcome (+)Gaspar et al 2009 retrospective 34 82%Feldbrin et al 2005 retrospective 9 6Karalezli et al 2004 retrospective 14 12Hodges 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. 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) EBS presentation
    24. 24. Thank you EBS presentation

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