Advertisement

Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases

  • Yousef MarwanEmail author
  • Bashar Dahrab
  • Ali Esmaeel
  • Samir Abdulrazik Ibrahim
  • Jassim Al-Failakawi
Original Article • SPINE - COCCYX

Abstract

Background

Coccydynia can lead to significant functional disability and worsening of quality of life if not properly managed. In this study, we aim to assess the outcomes of extracorporeal shock wave therapy in patients with coccydynia.

Methods

A prospective case series study was carried out from January to December 2015. Twenty-three patients, mean age of 38.3 ± 12.1 (range 18–64), were included. The majority were females (13; 56.5%), had pain for at least 6 weeks (17; 73.9%) and had trauma to the sacrococcygeal region (17; 73.9%). They had three sessions (one session per week for three consecutive weeks) of focused shock wave therapy directed to the maximal point of coccygeal tenderness. Numerical pain scale and Oswestry disability index were used to assess outcome.

Results

Six (26.1%) patients did not complete the follow-up because of no, or minimal, improvement of their pain. After 6 months of follow-up, the median numerical pain scale significantly decreased from 7.0 ± 4.0 to 2.0 ± 2.0 among the 17 patients with coccydynia (p < 0.001). The median Oswestry disability index improved from 24.0 ± 9.0 before therapy to 8.0 ± 9.0 at final follow-up (p < 0.001). Before treatment, 12 (70.6%) patients had moderate-to-severe disability. In contrast, no patients had severe disability and only one (5.9%) patient had moderate disability at final follow-up (p < 0.001).

Conclusion

Extracorporeal shock wave therapy had favorable outcomes in treating coccydynia. The majority of patients had partial relief of their pain and disability following this therapy.

Keywords

Coccydynia Coccygodynia Coccyx Pain Extracorporeal shock wave therapy 

Notes

Acknowledgement

We would like to thank the physiotherapy team of Al-Razi Orthopaedic hospital for their help throughout the study.

Compliance with ethical standards

Conflict of interest

All authors declare no conflict of interest.

Ethical standards

This research was given ethical approval from our institutional review board (IRB). The study complies with the current laws of our country.

References

  1. 1.
    Nathan ST, Fisher BE, Roberts CS (2010) Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br 92(12):1622–1627CrossRefPubMedGoogle Scholar
  2. 2.
    Maigne JY, Guedj S, Straus C (1994) Idiopathic coccygodynia: lateral roentgenograms in the sitting position and coccygeal discography. Spine 19(8):930–934CrossRefPubMedGoogle Scholar
  3. 3.
    Pennekamp PH, Kraft CN, Stütz A, Wallny T, Schmitt O, Diedrich O (2005) Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma 59(6):1414–1419CrossRefPubMedGoogle Scholar
  4. 4.
    Maigne JY, Pigeau I, Aguer N, Doursounian L, Chatellier G (2011) Chronic coccydynia in adolescents. A series of 53 patients. Eur J Phys Rehabil Med 47(2):245–251PubMedGoogle Scholar
  5. 5.
    Postacchini F, Massobrio M, Idiopathic coccygodynia (1983) Analysis of fifty-one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg Am 65(8):1116–1124CrossRefPubMedGoogle Scholar
  6. 6.
    Maigne JY, Doursounian L, Chatellier G (2000) Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine (Phila Pa 1976) 25(23):3072–3079CrossRefGoogle Scholar
  7. 7.
    Woon JT, Maigne JY, Perumal V, Stringer MD (2013) Magnetic resonance imaging morphology and morphometry of the coccyx in coccydynia. Spine (Phila Pa 1976) 38(23):E1437–E1445CrossRefGoogle Scholar
  8. 8.
    Marwan YA, Al-Saeed OM, Esmaeel AA, Kombar OR, Bendary AM, Azeem ME (2014) Computed tomography-based morphologic and morphometric features of the coccyx among Arab adults. Spine (Phila Pa 1976) 39(20):E1210–E1219CrossRefGoogle Scholar
  9. 9.
    Doursounian L, Maigne JY, Jacquot F (2015) Coccygectomy for coccygeal spicule: a study of 33 cases. Eur Spine J 24(5):1102–1108CrossRefPubMedGoogle Scholar
  10. 10.
    Richette P, Maigne JY, Bardin T (2008) Coccydynia related to calcium crystal deposition. Spine (Phila Pa 1976) 33(17):E620–E623CrossRefGoogle Scholar
  11. 11.
    Kim HS, Yang SH, Park HJ, Park HB, Cho HS (2013) Glomus tumor as a cause of coccydynia. Skeletal Radiol 42(10):1471–1473CrossRefPubMedGoogle Scholar
  12. 12.
    Gavriilidis P, Kyriakou D (2013) Sacrococcygeal chordoma, a rare cause of coccygodynia. Am J Case Rep 14:548–550CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hodges SD, Eck JC, Humphreys SC (2004) A treatment and outcomes analysis of patients with coccydynia. Spine J 4(2):138–140CrossRefPubMedGoogle Scholar
  14. 14.
    Maigne JY, Chatellier G, Faou ML, Archambeau M (2006) The treatment of chronic coccydynia with intrarectal manipulation: a randomized controlled study. Spine (Phila Pa 1976) 31(18):E621–E627CrossRefGoogle Scholar
  15. 15.
    Mitra R, Cheung L, Perry P (2007) Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician 10(6):775–778PubMedGoogle Scholar
  16. 16.
    Howard PD, Dolan AN, Falco AN, Holland BM, Wilkinson CF, Zink AM (2013) A comparison of conservative interventions and their effectiveness for coccydynia: a systematic review. J Man Manip Ther 21(4):213–219CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Ramsey ML, Toohey JS, Neidre A, Stromberg LJ, Roberts DA (2003) Coccygodynia: treatment. Orthopedics 26(4):403–405PubMedGoogle Scholar
  18. 18.
    Datir A, Connell D (2010) CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol 65(1):21–25CrossRefPubMedGoogle Scholar
  19. 19.
    Gopal H, Mc Crory C (2014) Coccygodynia treated by pulsed radio frequency treatment to the Ganglion of Impar: a case series. J Back Musculoskelet Rehabil 27(3):349–354CrossRefPubMedGoogle Scholar
  20. 20.
    Gunduz OH, Sencan S, Kenis-Coskun O (2015) Pain relief due to transsacrococcygeal Ganglion Impar block in chronic coccygodynia: a pilot study. Pain Med 16(7):1278–1281CrossRefPubMedGoogle Scholar
  21. 21.
    Trollegaard AM, Aarby NS, Hellberg S (2010) Coccygectomy: an effective treatment option for chronic coccydynia: retrospective results in 41 consecutive patients. J Bone Joint Surg Br 92(2):242–245CrossRefPubMedGoogle Scholar
  22. 22.
    Karadimas EJ, Trypsiannis G, Giannoudis PV (2011) Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J 20(5):698–705CrossRefPubMedGoogle Scholar
  23. 23.
    Bergkamp AB, Verhaar JA (1995) Dislocation of the coccyx: a case report. J Bone Joint Surg Br 77(5):831–832PubMedGoogle Scholar
  24. 24.
    Dean LM, Syed MI, Jan SA, Patel NA, Shaikh A, Morar K, Shah O (2006) Coccygeoplasty: treatment for fractures of the coccyx. J Vasc Interv Radiol 17(5):909–912CrossRefPubMedGoogle Scholar
  25. 25.
    Marwan Y, Husain W, Alhajii W, Mogawer M (2014) Extracorporeal shock wave therapy relieved pain in patients with coccydynia: a report of two cases. Spine J 14(1):e1–e4CrossRefPubMedGoogle Scholar
  26. 26.
    Lin SF, Chen YJ, Tu HP, Lee CL, Hsieh CL, Wu WL, Chen CH (2015) The effects of extracorporeal shock wave therapy in patients with coccydynia: a randomized controlled trial. PLoS One 10(11):e0142475CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Mannion AF, Balagué F, Pellisé F, Cedraschi C (2007) Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol 3(11):610–618CrossRefPubMedGoogle Scholar
  28. 28.
    Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine (Phila Pa 1976) 25(22):2940–2952CrossRefGoogle Scholar
  29. 29.
    Wang CJ, Wang FS, Yang KD, Weng LH, Hsu CC, Huang CS, Yang LC (2003) Shock wave therapy induces neovascularization at the tendon-bone junction. A study in rabbits. J Orthop Res 21(6):984–989CrossRefPubMedGoogle Scholar
  30. 30.
    Zelle BA, Gollwitzer H, Zlowodzki M, Bühren V (2010) Extracorporeal shock wave therapy: current evidence. J Orthop Trauma 24(Suppl 1):S66–S70CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2017

Authors and Affiliations

  • Yousef Marwan
    • 1
    • 2
    Email author
  • Bashar Dahrab
    • 1
  • Ali Esmaeel
    • 1
    • 3
  • Samir Abdulrazik Ibrahim
    • 1
  • Jassim Al-Failakawi
    • 1
  1. 1.Department of Orthopaedic SurgeryAl-Razi Orthopaedic HospitalSafat, Kuwait CityKuwait
  2. 2.Division of Orthopaedic Surgery, McGill University Health CentreMcGill UniversityMontrealCanada
  3. 3.Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine, Health Sciences CenterKuwait UniversityKuwait CityKuwait

Personalised recommendations