ebs coccygeal pain 2012
TRANSCRIPT
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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