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Published in: European Journal of Orthopaedic Surgery & Traumatology 5/2017

01-07-2017 | Original Article • SPINE - COCCYX

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

Authors: Yousef Marwan, Bashar Dahrab, Ali Esmaeel, Samir Abdulrazik Ibrahim, Jassim Al-Failakawi

Published in: European Journal of Orthopaedic Surgery & Traumatology | Issue 5/2017

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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.
Literature
1.
go back to reference Nathan ST, Fisher BE, Roberts CS (2010) Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br 92(12):1622–1627CrossRefPubMed Nathan ST, Fisher BE, Roberts CS (2010) Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br 92(12):1622–1627CrossRefPubMed
2.
go back to reference Maigne JY, Guedj S, Straus C (1994) Idiopathic coccygodynia: lateral roentgenograms in the sitting position and coccygeal discography. Spine 19(8):930–934CrossRefPubMed Maigne JY, Guedj S, Straus C (1994) Idiopathic coccygodynia: lateral roentgenograms in the sitting position and coccygeal discography. Spine 19(8):930–934CrossRefPubMed
3.
go back to reference Pennekamp PH, Kraft CN, Stütz A, Wallny T, Schmitt O, Diedrich O (2005) Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma 59(6):1414–1419CrossRefPubMed Pennekamp PH, Kraft CN, Stütz A, Wallny T, Schmitt O, Diedrich O (2005) Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma 59(6):1414–1419CrossRefPubMed
4.
go back to reference 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):245–251PubMed 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):245–251PubMed
5.
go back to reference 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):1116–1124CrossRefPubMed 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):1116–1124CrossRefPubMed
6.
go back to reference 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):3072–3079CrossRef 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):3072–3079CrossRef
7.
go back to reference 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–E1445CrossRef 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–E1445CrossRef
8.
go back to reference 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–E1219CrossRef 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–E1219CrossRef
9.
go back to reference Doursounian L, Maigne JY, Jacquot F (2015) Coccygectomy for coccygeal spicule: a study of 33 cases. Eur Spine J 24(5):1102–1108CrossRefPubMed Doursounian L, Maigne JY, Jacquot F (2015) Coccygectomy for coccygeal spicule: a study of 33 cases. Eur Spine J 24(5):1102–1108CrossRefPubMed
10.
go back to reference Richette P, Maigne JY, Bardin T (2008) Coccydynia related to calcium crystal deposition. Spine (Phila Pa 1976) 33(17):E620–E623CrossRef Richette P, Maigne JY, Bardin T (2008) Coccydynia related to calcium crystal deposition. Spine (Phila Pa 1976) 33(17):E620–E623CrossRef
11.
go back to reference Kim HS, Yang SH, Park HJ, Park HB, Cho HS (2013) Glomus tumor as a cause of coccydynia. Skeletal Radiol 42(10):1471–1473CrossRefPubMed Kim HS, Yang SH, Park HJ, Park HB, Cho HS (2013) Glomus tumor as a cause of coccydynia. Skeletal Radiol 42(10):1471–1473CrossRefPubMed
13.
go back to reference Hodges SD, Eck JC, Humphreys SC (2004) A treatment and outcomes analysis of patients with coccydynia. Spine J 4(2):138–140CrossRefPubMed Hodges SD, Eck JC, Humphreys SC (2004) A treatment and outcomes analysis of patients with coccydynia. Spine J 4(2):138–140CrossRefPubMed
14.
go back to reference 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–E627CrossRef 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–E627CrossRef
15.
go back to reference Mitra R, Cheung L, Perry P (2007) Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician 10(6):775–778PubMed Mitra R, Cheung L, Perry P (2007) Efficacy of fluoroscopically guided steroid injections in the management of coccydynia. Pain Physician 10(6):775–778PubMed
16.
go back to reference 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):213–219CrossRefPubMedPubMedCentral 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):213–219CrossRefPubMedPubMedCentral
17.
go back to reference Ramsey ML, Toohey JS, Neidre A, Stromberg LJ, Roberts DA (2003) Coccygodynia: treatment. Orthopedics 26(4):403–405PubMed Ramsey ML, Toohey JS, Neidre A, Stromberg LJ, Roberts DA (2003) Coccygodynia: treatment. Orthopedics 26(4):403–405PubMed
18.
go back to reference Datir A, Connell D (2010) CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol 65(1):21–25CrossRefPubMed Datir A, Connell D (2010) CT-guided injection for ganglion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol 65(1):21–25CrossRefPubMed
19.
go back to reference 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):349–354CrossRefPubMed 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):349–354CrossRefPubMed
20.
go back to reference 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):1278–1281CrossRefPubMed 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):1278–1281CrossRefPubMed
21.
go back to reference 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):242–245CrossRefPubMed 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):242–245CrossRefPubMed
22.
go back to reference Karadimas EJ, Trypsiannis G, Giannoudis PV (2011) Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J 20(5):698–705CrossRefPubMed Karadimas EJ, Trypsiannis G, Giannoudis PV (2011) Surgical treatment of coccygodynia: an analytic review of the literature. Eur Spine J 20(5):698–705CrossRefPubMed
23.
go back to reference Bergkamp AB, Verhaar JA (1995) Dislocation of the coccyx: a case report. J Bone Joint Surg Br 77(5):831–832PubMed Bergkamp AB, Verhaar JA (1995) Dislocation of the coccyx: a case report. J Bone Joint Surg Br 77(5):831–832PubMed
24.
go back to reference 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):909–912CrossRefPubMed 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):909–912CrossRefPubMed
25.
go back to reference 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–e4CrossRefPubMed 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–e4CrossRefPubMed
26.
go back to reference 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):e0142475CrossRefPubMedPubMedCentral 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):e0142475CrossRefPubMedPubMedCentral
27.
go back to reference Mannion AF, Balagué F, Pellisé F, Cedraschi C (2007) Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol 3(11):610–618CrossRefPubMed Mannion AF, Balagué F, Pellisé F, Cedraschi C (2007) Pain measurement in patients with low back pain. Nat Clin Pract Rheumatol 3(11):610–618CrossRefPubMed
28.
go back to reference Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine (Phila Pa 1976) 25(22):2940–2952CrossRef Fairbank JC, Pynsent PB (2000) The Oswestry disability index. Spine (Phila Pa 1976) 25(22):2940–2952CrossRef
29.
go back to reference 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):984–989CrossRefPubMed 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):984–989CrossRefPubMed
30.
go back to reference Zelle BA, Gollwitzer H, Zlowodzki M, Bühren V (2010) Extracorporeal shock wave therapy: current evidence. J Orthop Trauma 24(Suppl 1):S66–S70CrossRefPubMed Zelle BA, Gollwitzer H, Zlowodzki M, Bühren V (2010) Extracorporeal shock wave therapy: current evidence. J Orthop Trauma 24(Suppl 1):S66–S70CrossRefPubMed
Metadata
Title
Extracorporeal shock wave therapy for the treatment of coccydynia: a series of 23 cases
Authors
Yousef Marwan
Bashar Dahrab
Ali Esmaeel
Samir Abdulrazik Ibrahim
Jassim Al-Failakawi
Publication date
01-07-2017
Publisher
Springer Paris
Published in
European Journal of Orthopaedic Surgery & Traumatology / Issue 5/2017
Print ISSN: 1633-8065
Electronic ISSN: 1432-1068
DOI
https://doi.org/10.1007/s00590-016-1896-2

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