Morphometric evaluation of coccyx in patients with coccydynia and classification

Yıl 2020, Cilt: 4 Sayı: 1, 61 - 67, 02.03.2020

Birol Özkal Seda Avnioğlu Büşra Candan

https://doi.org/10.30565/medalanya.636497

Cited By: 3

Öz

Aim: This study aimed to aimed to classiffication the morphological and pathological anatomic features of patients with coccydynia.

Patients and Method: Patients over 16 years of age who were admitted to Alanya Alaaddin Keykubat University Educational Research Hospital with complaints of coccydynia between April 2015 and April 2018, were included in the study. The sitting and standing coccyx and anterior-posterior pelvic radiographs of the patients were examined retrospectively.

Results: It was observed that coccyx scoliosis, hypermobility, and dislocation were unrelated to sacrococcygeal angulation. There was a positive correlation between sacrococcygeal and intercoccygeal angles in the measurements of sitting and standing coccyx radiographs of the patients. There was a correlation between the length of the sacrum and length of the coccyx and also the intercoccygeal angle and coccyx length in the unoperated patients. There was a positive correlation between length of the sacrococcygeal joint and sacrococcygeal angle in males. Fusion in the sacrococcygeal joint was less in females. 

Conclusion: In the evaluation of patients with coccydynia, it should not be forgotten that the coccyx is a spinal segment which can move in all planes and develop pathology. Side and AP positioned sitting and standing dynamic radiography is an effective method for the detection of pathology in this patients. New classification including pathology in all three planes is needed in the classification of patients with coccydynia. We believe that our classification will eliminate this deficit. 

Anahtar Kelimeler

Coccydynia, Coccyx, Classification, Morphology

Koksidinialı Hastalarda koksiksin morfometrik değerlendirilmesi ve sınıflandırması

Öz

Amaç: Koksidinalı hastalarda morfolojik ve patolojik anatominin özellikleri sınıflandırmayı amaçladık.

Hastalar ve yöntem: Nisan 2015 - Nisan 2018 tarihleri arasında Alanya Alaaddin Keykubat Üniversitesi Eğitim Araştırma Hastanesine koksidina yakınması ile başvuran 16 yaş ve üzerindeki hastalar çalışmaya dahil edildi. Hastaların oturarak ve ayakta çekilen koksiks ve ön-arka pelvis grafileri retrospektif olarak incelendi.

Bulgular: Koksiksin skolyozunun, hipermobilitesinin ve dislokasyonunun sakrokoksigeal açılanma ile ilişkili olmadığı görüldü. Hastaların oturarak ve ayakta çekilen koksiks grafi ölçümlerinde sakrokoksigeal ve interkoksigeal açıları arasında pozitif yönlü anlamlı bir ilişki bulundu. Ameliyat olmamış hastalarda sakrum ve koksiks uzunluğu arasında ve interkoksigeal açı ve koksiks uzunluğu arasında ilişki bulundu. Erkeklerde sakrokoksigeal eklem uzunluğu ile sakrokoksigeal açı ilişkili bulundu. Kadınlarda sakrokoksigeal eklemde füzyonun daha düşük olduğu tespit edildi. 

Sonuç: Koksidina yakınması ile gelen hastalar değerlendirilirken koksiksin tüm düzlemlerde hareket edebilen ve patoloji geliştirebilen bir omurga segmenti olduğu unutulmamalıdır. Bu hastaların yan ve AP pozisyonda oturarak ve ayakta çekilen dinamik direkt grafilerle değerlendirilmesi patolojinin bulunmasında etkili bir yöntemdir. Koksidinalı hastalarının sınıflandırılmasında her üç düzlemde patoloji içeren yeni sınıflandırma gereklidir. Sınıflandırmamızın bu eksikliği gidereceğini düşünmekteyiz.

Anahtar Kelimeler

Koksidinia, Koksiks, Sınıflandırma, Morfoloji

Kaynakça

• 1. Lirette LS, Chaiban G, Tolba R, Eissa H. Coccydynia: An Overview of the Anatomy, Etiology, and Treatment of Coccyx Pain. Ochsner J. 2014;14(1):84-7. PMID: 24688338
• 2. Albrecht S, Hicks MJ, Antalffy B. Intracoccygeal and pericoccygeal glomus bodies and their relationship to coccygodynia. Surgery. 1994;115:1-6. PMID: 8284749
• 3. Özkal B. Surgical Treatment Outcomes in Patients with Coccydynia. Bozok Med J. 2018;8(1):103-8. 4. Eryilmaz R, Isık A, Okan I, Bilecik T, Yekeler E, Sahin M. Does Sacrococcygeal Angle Play a Role on Pilonidal Sinus Etiology? Prague Medical Report. 2015;116(3):219–24. doi: 10.14712/23362936.2015.61.
• 5. Dalbayrak S, Yaman O, Yılmaz T, Yılmaz M. Treatment Principles for Coccygodynia. Turk Neurosurg. 2014;24(4):532-7. doi:10.5137/1019-5149.JTN.9505-13.0
• 6. Yoon MG, Moon MS, Park BK, Lee H, Kim DH. Analysis of Sacrococcygeal Morphology in Koreans Using Computed Tomography. Clinics in Orthopedic Surgery. 2016;8:412-9. doi:10.4055/cios.2016.8.4.412
• 7. Lee JY, Gıl YC, Shın KJ, Kım JN, Joo SH, Koh KS, Song WC. An Anatomical and Morphometric Study of the Coccyx Using Three-Dimensional Reconstruction. The Anatomıcal Record. 2016;299:307–12. doi: 10.1002/ar.23300.
• 8. Tetiker H, Koşar Mİ, Çullu N, Canbek U, Otağ İ, Taştemur Y. MRI-based detailed evaluation of the anatomy of the human coccyx among Turkish adults. Niger J Clin Pract. 2017;20:136-42. doi: 10.4103/1119-3077.198313
• 9. Woon JTK, Perumal V, Maigne JY, Stringer MD. CT morphology and morphometry of the normal adult coccyx. Eur Spine J. 2013;22:863-70. PMID: 23192732
• 10. Postacchini F, Massobrio M. Idiopathic coccygodynia. Analysis of fifty-one operative cases and a radiographic study of the normal coccyx. J Bone Joint Surg [Am]. 1983;65:1116-24. PMID: 6226668
• 11. Traycoff RB, Crayton H, Dodson R. Sacrococcygeal pain syndromes: diagnosis and treatment. Orthopedics. 1989;12:1373-7. PMID: 2678043
• 12. Nathan ST, Fisher BE, Roberts CS. Revıew Artıcle Coccydynia A Revıew Of Pathoanatomy, Aetıology, Treatment And Outcome. J Bone Joint Surg [Br]. 2010;92:1622-7. doi: 10.1302/0301-620X.92B12.25486
• 13. Maigne JY, Guedj S, Straus C. Idiopathic coccygodynia: lateral roentgenograms in the sitting position and coccygeal discography. Spine. 1994;19:930-4. PMID: 8009351
• 14. Maigne JY, Doursounian L, Chatellier G. Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine. 2000;25:3072-9. PMID: 11145819
• 15. Kim NH, Suk KS. Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Med J. 1999;40:215-20. PMID:10412331
• 16. Kerr EE, Benson D, Schrot RJ. Coccygectomy for chronic refractory coccygodynia: clinical case series and literature review. J Neurosurg Spine. 2011;14:654-63. PMID: 21332277
• 17. Shalaby SA, Eid EM, Allam OAA, Ali MA, Gebba MA. Morphometric Study of the Normal Egyptian Coccyx from (Age 1-40 Year). International Journal of Clinical and Developmental Anatomy. 2015;1(2): 32-41. doi: 10.11648/j.ijcda.20150102.13
• 18. Indiran V, Sivakumar V, Maduraimuth P. Coccygeal Morphology on Multislice Computed Tomography in a Tertiary Hospital in India, Asian Spine J. 2017;11(5):694-9. PMID: 29093777
• 19. Fogel GR, Cunningham PY, Esses SI. Coccygodynia: evaluation and management. J Am Acad Orthop Surg. 2004;12(1):49-54. PMID:14753797
• 20. Przybylski P, Pankowicz M, Boc´kowska A, Chehab EC, Stas´kiewicz G, Andrzej KM, Drop A. Evaluation of coccygeal bone variability, intercoccygeal and lumbo-sacral angles in asymptomatic patients in multislice computed tomography. Anat Sci Int. 2013; 88:204–11. PMID: 23700101