Coccydynia; Little-Known Cause of Low Back Pain

Yıl 2017, Cilt: 1 Sayı: 3, 68 - 74, 31.12.2017

İbrahim Tekeoğlu , Yıldıray Aydın

Öz

The true incidence of coccygodynia is unknown. But female gender and obesity are the most important risk factors for coccygodynia. It is five times more common in women than in men. The most common cause of coccygodynia is a direct fall on the coccyx or recurrent micro-trauma. Recurrent trauma and repeated stress, such as riding, cycling, motorcycle and sitting on a hard floor for a long time can also be effective in the formation of coccygodynia. Etiology is not known in 30% of patients. The first step in the treatment of coccygodynia should be pharmacological treatment. Analgesics, anti-inflammatory drugs, anticonvulsants, antidepressants, and opioids may be used in conjunction with sitting wheels. Physical therapy agents, manual therapy, algological procedures and surgical procedures are applied if there is no relief of symptoms.

Anahtar Kelimeler

Coccygodynia, etiology, incidence, treatment

Koksidini; Bel Ağrısının Az Bilinen Bir Nedeni

Öz

Koksidininin gerçek insidansı bilinmemektedir ancak kadın cinsiyet ve obezite koksidini için en önemli risk faktörleridir. Erkeklere göre kadınlarda 5 kat daha fazla görülmektedir. Koksidininin en sık görülen nedeni koksiks üzerine doğrudan düşme veya tekrarlayan mikrotravmalardır. Temas sporları (binicilik, bisiklet, motosiklet sürme) gibi tekrarlanan stres, tekrarlayan minör travma ve uzun süre sert zeminde oturmak da koksidini oluşmasında etkili olabilmektedir. Etiyoloji, hastaların % 30'unda ortaya konamamaktadır. Koksidini tedavisinde ilk tercih farmakolojik tedavi ile birlikte oturma simitleri yöntemi olmalıdır. Analjezik ajanlar, nonsteroid anti-inflamatuar ilaçlar, antikonvülzanlar, antidepresanlar ve opioidler kullanılabilir. Bunlara cevap alınmazsa fizik tedavi ajanları, manuel terapi, algolojik girişimler ve cerrahi prosedürler uygulanmaktadır.

Anahtar Kelimeler

Koksidini, etyoloji, insidans, tedavi

Kaynakça

• 1. Lesley SL, Gassan C, Reda T et al. Coccydynia: An Overview of the Anatomy, Etiology,and Treatment of Coccyx Pain. The Ochsner Journal 2014;14:84-87
• 2. Nathan ST, Fisher BE, Roberts CS. Coccydynia: a review of pathoanatomy, aetiology, treatment and outcome. J Bone Joint Surg Br. 2010;92(12):1622-7
• 3. Dampc B, Słowiński K. Coccygodynia - pathogenesis, diagnostics and therapy. Review of the writing. Pol Przegl Chir. 2017;89(4):33- 40. doi: 10.5604/01.3001.0010.3909
• 4. Jose De A, Santiago C. Coccygodynia: A Proposal for an algorithm for treatment. The Journal of Pain 200:4 (5):257-266
• 5. Tetiker H, Koşar MI, Çullu N, et al. MRI-based detailed evaluation of the anatomy of the human coccyx among Turkish adults. Niger J Clin Pract. 2017;20(2):136-142. doi: 10.4103/1119-3077.198313
• 6. Balain B, Eisenstein SM, Alo GO, et al. Coccygectomy for coccydynia: case series and review of literature. Spine 2006;31:E414- 20.
• 7. Maigne JY, Guedj S, Straus C. Idiopathic coccygodynia: lateral roentgenograms in the sitting position and coccygeal discography. Spine 1994;19:930-4
• 8. Oh CS, Chung IH, Ji HJ, et al. Clinical implications of topographic anatomy on the ganglion impar. Anesthesiology 2004;101(1):249– 50
• 9. Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: Role of body mass index and coccygeal trauma. Spine 2000;25:3072-3079
• 10. Deniz R, Ozen G, Yilmaz-Oner S, et al. Ankylosing spondylitis and a diagnostic dilemma: coccydynia. Clin Exp Rheumatol. 2014;32(2):194-8
• 11. Maigne JY, Pigeau I, Aguer N, et al. Chronic coccydynia in adolescents. A series of 53 patients.Eur J Phys Rehabil Med.2011;47(2):245-51
• 12. Pennekamp PH, Kraft CN, Stütz A, et al. Coccygectomy for coccygodynia: does pathogenesis matter? J Trauma. 2005;59(6):1414-9
• 13. 13. Maigne JY, Rusakiewicz F, Diouf M. Postpartum coccydynia: a case series study of 57 women.Eur J Phys Rehabil Med. 2012;48(3):387-92. Epub 2012
• 14. Veli Ç, Şule O, Muhammet FS. Literatür eşliğinde koksidinia. Abant Medical Journal 2014;(3)3:306-312
• 15. Ciftci B, İkbali Afsar Sİ, Uzunkulaoğlu A. Coccydynia. Journal of Physical Medicine & Rehabilitation Sciences, 2016; (19)1:70-75
• 16. Tekin L, Yılmaz B, Alaca R, et al. Coccyx fractures in patients with spinal cord injury. Eur J Phys Rehabil Med. 2010;46(1):43-6
• 17. Kim HS, Yang SH, Park HJ, et al. Glomus tumor as a cause of coccydynia. Skeletal Radiol. 2013;42(10):1471-3. doi: 10.1007/ s00256-013-1654-z
• 18. Cockbain AJ, Morrison CP, Davies JB. Coccydynia secondary to a large pelvic tumor of anorectal origin.Spine J. 2011;11(7):683. doi: 10.1016/j. spine.2011.05.014
• 19. 19. Uglialoro AD, Beebe KS, Hameed M, et al. A rare case of intraosseous benign notochordal cell tumor of the coccyx. Orthopedics. 2009;32(6):445
• 20. Lath R, Rajshekhar V, Chacko G, et al. Sacral haemangioma as a cause of coccydynia. Neuroradiology.1998;40(8):524-6
• 21. Singh S, Nagaraj C, Khare GN, et al. Multicentric tuberculosis at two rare sites in an immunocompetent adult. J Orthop Traumatol. 2011;12(4):223-5
• 22. Richette P, Maigne JY, Bardin T. Coccydynia related to calcium crystal deposition. Spine (Phila Pa 1976). 2008;33(17):E620-3
• 23. Moon SG, Kim NR, Choi JW, et al. Acute coccydynia related to precoccygeal calcific tendinitis.Skeletal Radiol. 2012;41(4):473-6. doi: 10.1007/s00256-011-1326
• 24. Hanelin LG, Sclamberg EL, Bardsley JL: Intraosseous lipoma of the coccyx: Report of a case. Radiology1975; 114:343- 344
• 25. Hodge L: Clinical management of coccydynia. Med Trial Tech 1979;25:277-28
• 26. Wray CC, Easom S, Hoskinson J. Coccydynia: etiology and treatment. J Bone Joint Surg Br 1991;73:335-338
• 27. Bayne O, Bateman JE, Cameron HU. The influence of etiology on the results of coccygectomy. Clin Orthop 1984;190:266- 272
• 28. Kinnett JG, Root L. An obscure cause of coccydynia: Case report. J Bone Joint Surg 1979;61:299
• 29. Tilscher IL, Kantor IL, Gangl W, et al. Coccygodynia: A diagnostic and therapeutic problem in orthopedics. Z Orthop Ihre Grenzgeb 1986;124:628-632
• 30. Kepski A, Rudnicki S. Arachnoid cyst of cauda equina: A contribution to the aetiology of coccydynia. Eurol Neurochir Pol 978;12:109-112
• 31. Ziegler DK, Batnitszky S. Coccygodynia caused by perineural cyst. Neurology 1984 ;43:829-830
• 32. Sundaresan N, Galicich JH, Chu FCH, et al. Spinal chordomas. J Neurosurg 1979; 50:312-319
• 33. Fogel G, Cunningham P, Esses S. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004; 12(1):49-54.
• 34. Capar B, Akpinar N, Kutluay E, et al. Coccygectomy in patients with coccydynia. Acta Orthop Traumatol Turc. 2007;41(4):277-80.
• 35. Patel R., Appannagari A, Whang P.G. Coccydynia. Curr Rev Musculoskelet Med, 2008; (1):223-226
• 36. Maigne JY, Chatellier G, Faou ML, et al. The treatment of chronic coccydynia with intra-rectal manipulation: a randomized controlled study. Spine (Phila Pa 1976). 2006;31(18):E621-7
• 37. Datir A, Connell D. CT-guided injection for gang-lion impar blockade: a radiological approach to the management of coccydynia. Clin Radiol. 2010;65(1):21-5
• 38. Van Kleef M, Barendse G, Wilmink J, et al. Percutaneous intradiscal radiofrequency thermocoagulation in chronic nonspecific low back pain. The Pain Clinic 1996; 9:259-268
• 39. Abdülkadir A, Atilla E, Serkan B, et al. Pulsed radiofrequency in the treatment coccygodynia. Ağrı2011;23(1):1-6
• 40. Gunduz OH, Sencan S, Kenis-Coskun O. Pain relief due to transsacrococcygeal ganglion impar block in chronic coccygodynia: a pilot study. Pain Med 2015; 16(7):1278-81
• 41. Cheng SW, Chen QY, Lin ZQ, et al. Coccygectomy for stubborn coccydynia. Chin J Traumatol.2011;14(1):25- 8
• 42. Wood K, Mehbod A. Operative treatment for coccygodynia. J Spinal Disord Tech. 2004;17:511–5. doi: 10.1097/01. bsd.0000128691.36652.16