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Radiographics 2020 Jul-Aug;40(4):1090-1106

From the Department of Radiology, Palmer College of Chiropractic-West Campus, 90 E Tasman Dr, San Jose, CA 95134 (M.R.S.); Department of Radiology, Cedars-Sinai Medical Center, Los Angeles, Calif (G.R.M.); and Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, Calif (D.B.P., A.T., E.A.W., J.S.G.).

The coccygeal region has complex anatomy, much of which may contribute to or be the cause of coccyx region pain (coccydynia). This anatomy is well depicted at imaging, and management is often dictated by what structures are involved. Coccydynia is a common condition that is known to be difficult to evaluate and treat. Read More

Balkan Med J 2020 Jun 23. Epub 2020 Jun 23.

Department of Neurosurgery, Okan University School of Medicine, İstanbul, Turkey.

Background: Coccydynia is a painful disease of the sacrococcygeal region, which causes discomfort, especially as symptoms are aggravated by sitting. It is frequently related to trauma and idiopathic causes, and the pain is mostly chronic in character. Percutaneous vertebroplasty and sacroplasty are the methods widely used in treating compression fractures and deficiency of vertebral body and sacrum. Read More

Neurol Res 2020 Jun 4:1-6. Epub 2020 Jun 4.

Department of Neurosurgery, Baylor Scott & White Health, Scott and White Medical Center , Temple, TX, USA.

Objective: Performing coccygectomy procedures on patients with psychiatric disorders and/or chronic low back pain have been previously thought of as contributing factors leading to inconsistent and often poor results. To determine if these two variables affect the post-operative pain relief obtained after coccygectomy, an analysis of the opioid requirements and pain descriptions before and after surgery was undertaken in each patient studied.

Methods: The hospital electronic medical records were searched, and only patients undergoing coccygectomy for chronic coccydynia were selected. Read More

BMC Anesthesiol 2020 May 11;20(1):110. Epub 2020 May 11.

Department of Anesthesiology, Balıkesir University Health Application and Research Hospital, 10100, Balikesir, Turkey.

Background: We aimed to evaluate pain scores one year after impar ganglion block in patients with coccydynia who did not benefit from conservative treatment.

Methods: The medical records of 29 patients with coccydynia were reviewed. Patients who were referred to the algology clinic and underwent impar ganglion blocks were retrospectively evaluated. Read More

Indian J Orthop 2020 Feb 13;54(1):104. Epub 2020 Jan 13.

Rutgers New Jersey Medical School, 90 Bergen St, D.O.C. Suite 3100, Newark, NJ 07103-2425 USA.

Autops Case Rep 2020 Jan-Mar;10(1):e2019115. Epub 2019 Dec 13.

Instituto Português de Oncologia do Porto Francisco Gentil, Entidade Pública Empresarial, Surgical Oncology Service. Porto, Portugal.

Tailgut cysts (TGCs) are rare congenital entities arising from remnants of the embryological postanal primitive gut. Malignancy in TGCs is rare, with the majority being adenocarcinomas and carcinoid tumors. A search of the published literature yielded only 27 cases of adenocarcinoma developing in TGCs. Read More

Medicine (Baltimore) 2020 Feb;99(6):e18860

Department of Traditional Medicine, Kaohsiung Chang Gung Memorial Hospital.

Rationale: Coccyx fracture is an injury usually caused by trauma. In most cases, the fractures recover after conservative therapy. For refractory cases that exhibit coccydynia after more than 2 months of conservative treatment, coccygectomy is indicated. Read More

Regen Med 2019 12 21;14(12):1151-1154. Epub 2020 Jan 21.

Department of Orthopaedics, Emory University, Johns Creek, GA 30097, USA.

To describe the successful treatment of coccydynia using ultrasound-guided injection of platelet-rich plasma.  Outpatient orthopedic practice. 17-year-old female with BMI of 42. Read More

World Neurosurg 2020 Mar 19;135:e567-e572. Epub 2019 Dec 19.

Department of Neurosurgery, Tulane University School of Medicine, New Orleans, Louisiana, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada, West Indies.

Objective: The sacral dorsal rami form the posterior sacrococcygeal plexus (PSCP), which has been scantly studied. This study's goal was to clarify the PSCP s detailed anatomy and discuss its clinical relevance.

Methods: Ten sides of 5 fresh-frozen cadavers were dissected for this research. Read More

Spine J 2019 12;19(12):2044

Department of Physical Medicine and Rehabilitation, Coccyx Pain Center, Rutgers New Jersey Medical School, 90 Bergen St, D.O.C. Suite 3100, Newark, NJ 07103-2425, USA.

J Med Case Rep 2019 Nov 21;13(1):339. Epub 2019 Nov 21.

, Baghdad, Iraq.

Background: This case series describes, for the first time, to the author's knowledge, a novel treatment for coccydynia. Tarsal tunnel block with lignocaine only brought relief of chronic coccydynia lasting more than 6 months in three patients. The author adopts the theory that the myelin sheath of the posterior tibial nerve will convey the lipid-soluble lignocaine upward toward the dorsal root ganglia and the nerve roots of the lumbar spine through the uninterrupted myelin sheath, which is itself mainly formed of lipids. Read More

Ann Coloproctol 2019 Oct 31;35(5):268-274. Epub 2019 Oct 31.

Division of Colorectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Purpose: Tailgut cysts are rare congenital or developmental lesions that arise from vestiges of the embryological hindgut. They are usually present in the presacral space. We report our single-center experience with managing tailgut cysts. Read More

Turk J Med Sci 2019 Oct 24;49(5):1555-1559. Epub 2019 Oct 24.

Department of Anesthesia and Reanimation, Health Sciences University, Gülhane Training and Research Hospital, Ankara, Turkey

Background/aim: Ganglion impar blockis used for the treatment of chronic coccygodynia. Pulsed radiofrequency (PRF) of the ganglion impar is a promising novel technique. The aim of this study was to determine and compare the efficacy of the blockade and PRF of the ganglion impar. Read More

Am J Phys Med Rehabil 2019 08;98(8):e101

From the Department of Physical Medicine and Rehabilitation, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey.

Schmerz 2019 Dec;33(6):549-554

Interdisziplinäre Schmerzambulanz, Klinikum der Universität München - Campus Innenstadt, LMU München, Pettenkoferstr. 8a, 80336, München, Deutschland.

This article presents the case of a 46-year-old woman with fibromyalgia with an undetected fracture of the coccyx. The heterogeneity of the symptoms of patients suffering from fibromyalgia including chronic widespread pain, vegetative and functional disorders, mental and physical exhaustion as well as sleep disorders can cause accidentally undetected comorbidities, especially if these are rare and predominantly present with pain as the main symptom. In the present case the reason for symptoms was detected only after 14 months of ineffective therapies and diagnostic procedures. Read More

Vet Anaesth Analg 2019 09 8;46(5):707-708. Epub 2019 Jun 8.

Dick White Referrals, Station Farm, Six Mile Bottom, UK.

Eur J Radiol Open 2019 20;6:187-191. Epub 2019 May 20.

Department of Radiological Sciences, Oncology and Pathology, "Sapienza" - University of Rome, Radiology Unit - Sant'Andrea University Hospital, Via di Grottarossa, 1035, 00189 Rome, Italy.

Objective: To evaluate the impact of the pubococcygeal line (PCL) position on hiatal descent grading, comparing the method recommended by the official guidelines with the other two most common methods reported in literature.

Methods: Female patients prospectively included performed dynamic-MR (1,5 T) in supine position. Rectum and vagina were filled with ultrasound gel. Read More

J Am Osteopath Assoc 2019 Jun;119(6):395-400

A 21-year-old man with atypical coccydynia that radiated bilaterally to his thigh and lower back came for treatment 10 years after coccyx trauma. Pertinent review of systems showed unintentional weight loss of 20 lb over the past 1 to 3 years, a body mass index of 14.94, significant depression, and poor concentration. Read More

Surg Case Rep 2019 May 9;5(1):75. Epub 2019 May 9.

Department of Colorectal Surgery, Charing Cross Hospital, Chelsea and Westminster Hospital, Imperial Healthcare Trust, London, UK.

Background: Rectal duplication cysts are rare gastrointestinal congenital duplicate cysts with various clinical presentations that require different management.

Case Presentation: We present a case of a lady with a double rectal duplicate cyst which was found incidentally on a follow-up CT abdomen and pelvis scan. The patient initially had a mucocele excision, and following that, she had a non-contrast CT abdomen and pelvis to investigate post-operative pain. Read More

Eur J Obstet Gynecol Reprod Biol 2019 May 2;236:259-260. Epub 2019 Apr 2.

Department of Obstetrics, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, China. Electronic address:

Asian J Neurosurg 2019 Jan-Mar;14(1):1-4

Department of Neurosurgery, Super Speciality Hospital and Government Medical College, Nagpur, Maharashtra, India.

A human tail is a rare congenital anomaly which mostly presents immediately after birth or in early childhood. Here, we are presenting a case of 17-year-old male who presented with 18-cm long tail, which was hidden till this age because of social stigma and shame. This is longest human tail reported of our knowledge. Read More

Enferm Clin 2019 Jul - Aug;29(4):245-247. Epub 2019 Mar 9.

UGC Medicina Maternofetal, Genética y Reproducción, Hospital Universitario Virgen del Rocío, Sevilla, España.

The coccyx is a bone with its own morphology and mobility and pain can occur due to trauma such as a difficult or instrumental delivery. Coccydynia can make it impossible to carry out the activities of daily life, its affects can be both physical and psychosocial, and causes great maternal morbidity. This article highlights the factors that predispose women to coccydynia and actions to relieve and improve it. Read More

Turk Neurosurg 2019 ;29(3):400-403

Gulhane Research and Education Hospital, Department of Orthopedics, Ankara, Turkey.

Aim: To evaluate the pelvic incidence (PI) of coccydynia patients treated by different methods and to determine whether it is a risk factor or a prognostic factor.

Material And Methods: Patients who were treated for coccydynia were evaluated retrospectively, and 110 patients were enrolled. Spinopelvic parameters were measured by using Surgimap software, and the position of the coccyx was evaluated according to the Postacchini classification. Read More

Orthopade 2019 Jan;48(1):92-95

Orthopädische Klinik für die Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V-Allee 3, 93077, Bad Abbach, Deutschland.

Background: Coccygodynia is still often considered a mystery, and many patients are not taken seriously with their problems and pain.

Case: A 51-year-old thin lady presented at our clinic with lifelong, persistent low back pain. The clinical examination indicated suspicion of coccygodynia. Read More

Int J Surg Case Rep 2019 24;54:63-65. Epub 2018 Nov 24.

Department of Neurosurgery, Baylor Scott and White Health, Temple, TX, USA.

Background And Importance: Coccydynia is a rare pain syndrome due to trauma to the coccyx that is diagnosed through history, physical, and sitting/standing lateral plain film radiographs. Coccydynia is typically managed conservatively with specialized cushions, NSAIDS, and physical therapy. In cases refractory to nonsurgical management, coccygectomy has a high success rate for pain reduction. Read More

J Palliat Med 2019 Mar 1;22(3):343-347. Epub 2018 Dec 1.

3 Spectrum Health Medical Group , Palliative Care Medicine, Grand Rapids, Michigan.

Introduction: Intravenous lidocaine is an option for intractable pain caused by advancing cancer and wound care. We report a case of intractable cancer pain and wound care pain managed with concurrent use of lidocaine administered as a twice daily intravenous bolus in addition to continuous intravenous infusion.

Case Description: A 31-year-old male with rapidly progressing locally advanced squamous cell cancer affecting the gluteal area developed extensive painful and purulent ulcerating wounds affecting the coccyx, superior gluteal cleft, and buttocks. Read More

Med Hypotheses 2018 Dec 14;121:70-73. Epub 2018 Sep 14.

Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address:

The aim of this study is to develop an alternative way to locate the sacral hiatus for blind caudal block from the anthropometrical data measured on 3D pelvic CT. The intersection of the line connecting two sacral cornua and the midline is considered the ideal point (IP) for caudal block. The mean length from the coccyx tip to the IP was measured using 3D pelvic CT images in 30 men and 30 women and was 6. Read More

Neurol Neurochir Pol 2018 Sep - Oct;52(5):612-617. Epub 2018 Aug 28.

Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.

Aim Of The Study: To define the effectiveness of ganglion Impar block in improving neuropathic pain.

Materials And Methods: Patients who had pain around the coccyx for more than three months and did not respond to conservative treatment were included in this study. All the patients underwent fluoroscopy guided transsacrococcygeal ganglion Impar block with injecting 3 mL of 0. Read More

Adv Biomed Res 2018 20;7:112. Epub 2018 Jul 20.

Department of Emergency Medicine, Emergency Medicine Research Center, Al-Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.

Background: Pelvic fracture (PF) is the second-most prevalent cause of mortality after brain trauma among multiple trauma patients. Our aim was to examine the reliability of suggestive criteria for having no PF (NPF) according to the common reported clinical signs and symptoms (CSSs).

Materials And Methods: In the current prospective study, 3527 patients with multiple trauma were recruited according to the guideline of emergency medicine. Read More

J Med Ultrasound 2017 Oct-Dec;25(4):208-214. Epub 2017 May 3.

Department of Radiology, Faculty of Medicine, Fayoum University, Fayoum, Egypt.

Introduction: Anal pain is defined as pain originating from the anal canal or the perianal area that can be attributed to a variety of medical problems. The current study's aim was to evaluate the role of combined endoanal, transperineal, and in married women, transvaginal ultrasound in clarifying the etiology of anal pain among our patient study group.

Methodology: A total of 180 patients presented to our radiology department complaining of anal pain and were examined using transperineal, endoanal, and in women, transvaginal ultrasound aided with three-dimensional capability. Read More

BMJ Case Rep 2018 Jul 30;2018. Epub 2018 Jul 30.

Department of Ob/Gyn, Texas Tech University Health Science Center School of Medicine, Amarillo, Texas, USA.

An 18-year-old virginal woman was referred to the reproductive endocrinology clinic with primary amenorrhoea and secondary sexual development in the absence of pelvic pain. Additionally, she had significant congenital sensorineural hearing loss, autism, bipolar disorder and class III obesity. On physical examination, secondary sexual development was confirmed (Tanner 5 breasts and Tanner 4 pubic hair). Read More

Ann Surg Oncol 2018 Sep 6;25(9):2641. Epub 2018 Jul 6.

Department of Surgical Oncology, MD Anderson Cancer Center, Houston, TX, USA.

Introduction: The management of perirectal tumors often requires rectal wall resection, and sometimes a complete proctectomy is required. Access to posterior perirectal masses via a posterior, transcoccygeal approach (Kraske procedure) avoids dissection of the intraperitoneal rectum.

Patient: The patient was a 63-year-old male who presented to his primary care physician with debilitating perirectal pain of several months' duration. Read More

Interv Neuroradiol 2018 Oct 3;24(5):580-585. Epub 2018 Jul 3.

6 Department of Physical Medicine and Rehabilitation, Division of Pain Medicine, Faculty of Medicine, Marmara University, Istanbul, Turkey.

Objective Ganglion impar block (GIB) can be performed in patients with chronic coccygodynia who do not respond to conservative treatments. We investigated the effect of coccygeal dynamic patterns on the treatment outcome in patients with chronic coccygodynia treated with GIB. Materials and methods We retrospectively analyzed the data for patients diagnosed with chronic coccygodynia who underwent GIB only once by a transsacrococcygeal method under fluoroscopy guidance in our Pain Medicine Clinic. Read More

Int J Surg Case Rep 2018 28;49:74-77. Epub 2018 Jun 28.

Department of Surgery, Kure City Medical Association Hospital, Japan; Department of Gastroenterological and Transplant Surgery Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Japan.

Introduction: Spinal tuberculosis (TB) is the most common manifestation of extra-pulmonary TB. TB of the lumbosacral junction is rare and occurs in only 1 to 2% of all cases of spinal TB. Moreover, isolated sacrococcygeal TB is extremely rare. Read More

Cureus 2018 Apr 2;10(4):e2407. Epub 2018 Apr 2.

Surgery, Max Hospital Vaishali.

Coccydynia in adult patients is not uncommon and is frequently neglected. Coccydynia is mostly associated with fall on buttocks. In long-standing cases, coccydynia can be debilitating. Read More

J Bodyw Mov Ther 2018 Apr 19;22(2):261-265. Epub 2017 Jun 19.

S.O.M.A. Istituto Osteopatia Milano, Milan (MI), Italy; Manima Non-Profit Organization Social Assistance and Healthcare, Via Franchetti 4, 20124 Milan (MI), Italy. Electronic address:

Background: Coccydynia is a disorder associated with pain/discomfort at the base of the spine. The role of osteopathic manipulative treatment (OMT) in chronic coccydynia as well as for low back pain (LBP) and radicular pain (RP) associated with coccydynia, has not previously been investigated. This study seeks to analyse the effects of OMT on chronic coccydynia compared to physical therapy and pharmacological treatment (PTPT). Read More

Case Rep Anesthesiol 2018 29;2018:5832401. Epub 2018 Apr 29.

Spine & Pain Institute of New York, New York City, NY, USA.

Coccydynia can be difficult to resolve with conventional treatment options. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for chronic pain, but its application has not been described in the context of coccydynia. We used DRG stimulation treatment in a patient suffering from intractable coccyx pain. Read More

Dtsch Arztebl Int 2018 May;115(18):326

J Emerg Med 2018 08 18;55(2):e33-e35. Epub 2018 May 18.

Department of Physical Medicine and Rehabilitation, Newark, New Jersey.

Background: Water slides and rides are increasingly popular attractions at amusement parks. There has been some documentation of various patterns of injury associated with these rides, most notably vaginal injuries caused by water jets. But we find no previous medical publications reporting the association between water slides/rides with coccydynia (coccyx pain) and tailbone injuries. Read More

Asian J Neurosurg 2018 Apr-Jun;13(2):277-282

Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.

Introduction: Coccygodynia refers to a pathological condition in which pain occurs in the coccyx or its immediate vicinity. The pain is usually provoked by sitting or rising from sitting. Several studies have reported good or excellent results after coccygectomy especially in patients who are refractory to conservative treatment. Read More

Trauma Case Rep 2017 Dec 14;12:11-15. Epub 2017 Nov 14.

Carilion Clinic Department of Orthopedics, Roanoke, VA, USA.

Dislocation of the sacrococcygeal joint is a rare injury from trauma to the buttocks, most often from falling backwards. Standard of care for this injury has not been determined because it is rare. Left untreated this can cause coccydynia in the long-term. Read More

Pediatr Surg Int 2018 08 3;34(8):905. Epub 2018 Apr 3.

Department of Physical Medicine and Rehabilitation, Coccyx Pain Center, Rutgers New Jersey Medical School, 90 Bergen St, D.O.C. Suite 3100, Newark, NJ, 07103-2425, USA.

Radiography (Lond) 2018 May 1;24(2):e48-e50. Epub 2017 Nov 1.

Department of Medicine, University of Otago, Christchurch, New Zealand; New Zealand Brain Research Institute, Christchurch, New Zealand.

Magnetic susceptibility artefacts, caused by metallic objects, present a challenge in magnetic resonance imaging (MRI). In this case, MRI showed metal-induced artefact in the rectum of a 14-year-old girl who presented with pain in the coccyx after a snowboarding accident. Previous radiographs showed no evidence of metal in the area. Read More

Curr Pain Headache Rep 2018 Mar 19;22(4):28. Epub 2018 Mar 19.

Department of Anesthesiology, Jefferson Pain Center, Thomas Jefferson University Hospital, 834 Chestnut Street, Suite T-150, Philadelphia, PA, 19107, USA.

Purpose Of Review: Coccygodynia is pain within the coccyx area. The diagnosis is made clinically with symptoms of pain in the coccyx region and worsening pain in sitting position. The initial treatment is conservative therapy. Read More

Nihon Hinyokika Gakkai Zasshi 2018 ;109(2):90-95

Department of Urology, Japanese Red Cross Nagoya First Hospital.

(Objective) A FDA alert in 2011 warned about postoperative chronic pain following transvaginal mesh (TVM) for pelvic organ prolapse (POP). We studied cases with chronic pain after TVM, natural tissue repair (NTR) and laparoscopic salcocopopexy (LSC). (Methods) We retrospectively reviewed medical charts of patients who underwent POP operations in our hospital or were referred to us after POP operations in other hospitals between 2006 and 2016. Read More

Ann R Coll Surg Engl 2018 Jan 15;100(1):12-15. Epub 2017 Sep 15.

Royal Derby Hospital , Derby , UK.

Introduction The aetiology of coccydynia can be multifactorial, with several associated factors such as obesity, female gender and low mood. The long-term results of operative interventions, such as manipulation under anaesthesia and coccygectomy are variable, ranging from 63-90%. Materials and methods Our aim was to identify whether age, trauma and body mass index (BMI) were independent prognostic factors in coccydynia treatment. Read More

Eur Spine J 2018 05 12;27(5):1166-1171. Epub 2017 Dec 12.

Department of Orthopaedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey.

Objective: We compared the results of manual therapy combined with steroid injection with single steroid injection in the treatment of persistent coccydynia.

Patients And Methods: Combined therapy was performed in 21 patients (Group 1) and steroid injection in 23 patients (Group 2). We compared two groups and investigated the combined therapy group in details. Read More

Surg Neurol Int 2017 24;8:260. Epub 2017 Oct 24.

Department of Neurosurgery, Kaiser Permanente Medical Center, Los Angeles, California, USA.

Background: Saccrococcygeal teratomas (SCT) are derived from embryonic germ cell layers. They frequently present at the base of the coccyx within the pelvis. While these tumors are common in children, they are exceedingly rare in adults. Read More

Neurourol Urodyn 2018 03 26;37(3):971-977. Epub 2017 Oct 26.

Department of Surgical, Hospital Brugmann, Université libre de Bruxelles, Brussels, Belgium.

Aim: To describe a new minimal invasive approach of the gluteal region which will permit to perform neurolysis of the pudendal and cluneal nerves in case of perineal neuralgia due to an entrapment of these nerve trunks.

Method: Ten transgluteal approaches were performed on five cadavers. Relevant anatomic structures were dissected and further described. Read More

Folia Morphol (Warsz) 2018 21;77(2):397-399. Epub 2017 Sep 21.

Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece..

Sacrum is a triangular bone placed in the base of the spine and formed by the synostosis of five sacral vertebrae (S1-S5). Its upper part is connected with the inferior surface of the body of L5 vertebra forming the lumbosacral joint, while its lower part is connected with the base of the coccyx forming the sacrococcygeal symphysis, an amphiarthrodial joint. The existence of four pairs of sacral fora-mina in both anterior and posterior surface of the sacrum is the most common anatomy. Read More