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      An evaluation of two different methods of coccygectomy in patients with traumatic coccydynia

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          Abstract

          Purpose

          The aim of this study was to evaluate the results of partial and total coccyx excisions in patients with traumatic coccydynia resistant to conservative treatment.

          Patients and methods

          The study included 22 patients (from a total of 27) who underwent partial or total coccygectomy because of persistent coccydynia between December 2007 and January 2014. There were 15 females and 7 males with a mean age of 33.6 years (range 23–46 years). Partial coccygectomy was performed in 14 patients and total coccygectomy in 8. They were evaluated according to their pre- and postoperative visual analog scale (VAS) scores. The mean follow-up period was 28 months (range 16–48 months).

          Results

          The mean VAS scores in the total excision group were 8.88±0.64 preoperatively and 2.5±2.67 at the final postoperative follow-up examination. In the partial excision group, these values were 8.79±0.89 preoperatively and 2.5±2.85 postoperatively. No statistically significant difference was determined between the two groups with respect to the mean scores ( p>0.05). No rectum injury was seen in any patient. When the VAS scores of the patients were evaluated as a whole, excellent and good results were obtained in 78%. Patient satisfaction with the operation was 90%.

          Conclusion

          Coccyx excision is a successful treatment method in patients with long-term coccydynia who are resistant to conservative treatment. Two different surgical methods can be applied in the treatment and both of them have low complication rates and high patient satisfaction.

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          Most cited references 21

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          Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx.

          We studied the normal radiographic anatomy of the coccyx in 120 asymptomatic subjects and performed a retrospective review of the results in fifty-one patients who had had a partial or total coccygectomy for idiopathic coccygodynia during a twenty-year period. Of the asymptomatic subjects, the sacrococcygeal joint was fused in forty-four (37 per cent); the first intercoccygeal joint, in twelve (10 per cent); and the second intercoccygeal joint, in fifty-two (43 per cent). Four types of configuration of the coccyx were identified on the lateral radiographs. In Type I the coccyx was curved slightly forward, whereas in Type II the curve of the coccyx, which pointed straight forward, was more marked. In Type III the coccyx was angulated forward sharply, and in Type IV it was subluxated at the sacrococcygeal or the intercoccygeal joint. Most subjects (68 per cent) had a Type-I configuration. Of the fifty-one patients with idiopathic coccygodynia, twenty-six (51 per cent) showed fusion of the sacrococcygeal joint; six (12 per cent), of the first intercoccygeal joint; and twenty-five (49 per cent), of the second intercoccygeal joint. In most patients (69 per cent) the coccyx had a Type-II, III, or IV configuration. Thirty-one patients had undergone a partial coccygectomy and twelve, a total coccygectomy; in the remaining eight patients the extent of the coccygectomy could not be determined. The results of surgery were excellent or good in thirty-two (88 per cent) of the thirty-six patients who were followed for at least two years.(ABSTRACT TRUNCATED AT 250 WORDS)
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            Coccygectomy for coccygodynia: does pathogenesis matter?

            Severity of vertical impact to the coccyx can range from mere contusion to a dislocated fracture of the coccyx. With early conservative management, most patients have a good prognosis and heal within weeks to months after the initial trauma. Occasionally, persisting symptoms make a surgical intervention with coccygectomy necessary. We report on the results of patients surgically managed for traumatically induced, persisting coccygodynia and compare these to patients operatively treated for idiopathic coccygodynia. Sixteen patients with an average follow-up of 7.3 years were evaluated. Of these, eight were surgically treated for traumatic and eight for idiopathic coccygodynia. The clinical results were assessed by means of the Hambly Score and the Oswestry Low Back Pain Disability questionnaire. Patient satisfaction with the postoperative result was assessed by a visual analog scale. Seven of eight (88%) patients treated for traumatically induced coccygodynia had a good or excellent postoperative result, in contrast to only three of eight (38%) patients with idiopathic coccygodynia. The former group had better results in terms of sitting tolerance and general pain intensity as represented by the Oswestry Low Back Pain Disability questionnaire. According to the significantly better clinical results, personal satisfaction was clearly higher in the traumatic group. These results suggest that, in patients where all conservative treatment methods work to no avail, particularly those with traumatically induced persisting coccygodynia benefit from surgical intervention with coccygectomy.
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              A treatment and outcomes analysis of patients with coccydynia.

              Coccydynia is a painful condition of the terminal portion of the spine often resulting from direct trauma, childbirth or unknown etiology. This is a relatively rare condition with no universally accepted treatment protocol.
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                Author and article information

                Journal
                J Pain Res
                J Pain Res
                Journal of Pain Research
                Journal of Pain Research
                Dove Medical Press
                1178-7090
                2017
                12 April 2017
                : 10
                : 881-886
                Affiliations
                Department of Trauma and Orthopedics, Adana Numune Training and Research Hospital, Adana, Turkey
                Author notes
                Correspondence: Firat Seyfettinoğlu, Department of Trauma and Orthopedics, Adana Numune Training and Educational Hospital, Serinevler mah, Ege Bagtur Bulvarı, Yüreğir/Adana, Turkey, Tel +90 532 716 9721, Fax +90 322 355 0155, Email firatseyf@ 123456yahoo.com
                Article
                jpr-10-881
                10.2147/JPR.S129198
                5396938
                © 2017 Ogur et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Anesthesiology & Pain management

                partial excision, total excision, coccyx, visual analog scale

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