Coccydynia-A comprehensive review on etiology, radiological features and management options

Abstract

Coccydynia is a disabling condition characterized by pain in the coccyx region of the spine. The first description of the disease was given in as early as 1859. Since then a number of theories have been proposed by various researchers to explain the pathogenesis of the disease. Treatment options for coccydynia include ergonomic adaptation, manual therapy, injections and surgery. Despite being identified as a disease as early as 18th century, several uncertainties with respect to the origin of pain, predisposing factors and treatment outcomes of a wide range of treatment options persist till date. The current narrative review presents various aspects of the disease including pathoanatomy, clinical presentation, radiological features and management options for the disease.

Keywords: Coccydynia; Coccygectomy; Complications; Narrative review; Radiology; Surgical technique.

© 2020 Delhi Orthopedic Association. All rights reserved.

Figures

Fig. 1

Standing (left) and sitting (right) radiographs depicting the posterior subluxation at sacro-coccygeal joint in an obese patient.

Fig. 2

Schematic representation of six morphological variants of coccyx as described in literature.

Fig. 3

Radiographic depiction of six morphological variants of coccyx described in literature.

Fig. 4

A type 1 coccyx with a posterior spicule (blue arrow).

Fig. 5

Osteoid osteoma lesion at the last coccygeal segment, a rare cause of coccydynia.

Fig. 6

Antero-posterior and lateral radiographs with post-traumatic double subluxation at sacro-coccygeal and inter-coccygeal joints.

Fig. 7

Schematic diagram depicting the measurement of coccygeal mobility.

Fig. 8

Coccygeal mobility assessment using standing radiograph(left) and supine MRI (right).