3. COCCYDYNIA / COCCYGODYNIA
• Introduction:
• Implies pain in the region of coccyx.
• Term first coined by SIMPSON in 1859
• Simplistic classification based on aetiology was
given by NATHAN & ROBERTS
• Classification based on morphology of coocyx
was formulated by POSTACCHINI & MASSOBRIO
6. • 4 RUDIMENTARY VERTEBRAE FUSED
TOGETHER.
• PELVIC AND DORSAL SURFACES.
• BASE/UPPER END HAS AN OVAL FACET
ARTICULATING WITH THE SACRUM.
• 1ST COCCYGEAL VERTEBRA – RUDIMENTARY
TRANSVERSE PROCESS.
• REMAINING VERTEBRAE REPRESENTED BY
NODULES OF BONE.
7.
8. ATTACHMENTS OF COCCYX
• Coccygeus is attached to the lateral aspect of
the pelvic aspect of the last piece of sacrum
and the whole of coccyx.
• Levator ani is attached to the lower two
segments of the coccyx.
• The gluteus maximus arises from the lateral
margin of the lowest part of the dorsal aspect
of the sacrum and that of the coccyx.
• Sphincter anii externus.
9. AETIOLOGY
• Most common : Direct axial trauma.
• Idiopathic.
• During child birth (Labour)
• Repeatitive strian (Cycling, rowing)
• Poor Posture (Prolonged sitting with leaning
backward)
• Ageing
• Tumour – Chordoma, metastasis
• Infection – Pilonoidal sinus
10. CLASSIFICATION
A) BASED ON AETIOLOGY:
Idiopathic
Traumatic.
B) BASED ON PATHOLOGY:
Degeneration of sacro-coccygeal and inter-coccygeal discs and joints.
Morphology of Coccyx – type 2,3,4 are more prone
Mobility of coccyx - Hypermobile or posterior subluxation.
Referred pain – Lumbar pathology, spasm of pelvic floor muscles and
inflammation of peri-coccygeal soft tissues.
11. POSTACCHINI AND MASSOBRIO MORPHOLOGIC
CLASSIFICATION
• Type 1: Curved gently forward.
• Type 2: Has a marked curve with apex pointing straight forward.
• Type 3 : Angled forward sharply between 1st and 2nd or 2nd and 3rd
coccygeal segments.
• Type 4: Anteriroly subluxated at the level of the sacro-coccygeal
joint or between the 1st and 2nd intercoccygeal joint.
• Type 5: Coccygeal retroversion
• Type 6: Scoliotic deformity
12.
13. CLINICAL FEATURES
• Accounts for 1% of all non traumatic complaints of the spine .
• M:F – 1:5
• Pain and tenderness in the region of the lower sacrum, coccyx,
pericoccygeal tissues.
• Pain proportional to the duration of time spent sitting.
• Disproportionate increase in pain in pre-menstrual periods.
• Spasm of the pelvic floor muscles (Levator anii) as pain is often
present during defecation.
• At times associated with pyriformis syndrome.
14. Investigations
1) Routine Blood test: CBC, ESR, CRP, ALK Phos.
(in case of infection, neoplasm and inflammation)
2) Dynamic radiographs. (Standing v/s Sitting)
3) Steroid injections with or without local anaesthetics used as
diagnostic as well as therapeutic modality for coccydynia.
15.
16. Treatment
• CONSERVATIVE : Successful in 95% patients.
• Non steroidal anti-inflammatory drugs
• SIETZ bath
• Ring shaped cushions.
• Ergonomic adaptations:
Postural training
Use of rubber ring or firm corset.
• Physiotherapy
• Manual manipulation of coccyx.
17. Treatment
• Procedural :
• Sacro-coccygeal Corticosteroid injections with or without local
anaesthetics agents.
• Ganglion impar blocks. (Blockade of nociceptive and
sympathetic fibres)
•
• Radiofrequency theromocoagulation of ganglion impar.
• Trans sacral ammonium chloride injections.
18. Treatment
• Surgical :
• Coccygectomy – Complete OR Partial .
• Surgical removal of coccyx.
• Power’s technique :
• Gardner’s technique:
• Safer technique
• Less chance of infection
• No blind plane formation close to the rectum.
19. • Complications :
• Infection
• Posterior rectal wall injury
• Loss of anal sphincter control.
• Chance of rectal prolapse.
