ebs coccygeal pain 2012

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Surgical management of coccygeal pain

Hazem Akil, MD,MRCSEdMacquarie NeurosurgeryEvidence Based Surgery

presentationAugust 2012

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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

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Clinical case

• Underwent u/s guided injection with temporary relief of pain for one day

• Offered surgery afterwards

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Clinical question

• Is surgery effective in treatment of refractory coccydynia?

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Searchable question (PICO format)

• P: Patients with coccygeal pain• I: Surgery• C: • O: Pain relief

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Search strategy

• MEDLINE• EMBASE• SCOPUS

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Coccygeal pain Coccydynia Coccygodynia

*

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Coccygeal pain Coccydynia Coccygodynia

*Coccyx/ Coccy*

Focused subject heading Truncated Keyword

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*Coccyx/ Pain

64

Limit to english language/Humans

42

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Limit to english language/Humans

42

Therapy (Max. Sensitivity)

8

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*Coccyx/ Pain

64

Limit to english language/Humans

42

Therapy (Max. Sensitivity)

8

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Coccy* Pain Surg*

83

Limit to english language and humans

58

Final choice

20

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English language and Humans

150

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 7471 has positive

results

Balain et al 2006 case series 31 71%

Pennekamp et al 2005 retrospective 1688% (traumatic)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%

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%

Author(s) Year Type No of pts Outcome (+)

Author(s) Year Type No of pts Outcome (+)

Gaspar et al 2009 retrospective 34 82%

Feldbrin et al 2005 retrospective 9 6

Karalezli et al 2004 retrospective 14 12

Hodges 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

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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)

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Thank you