American Journal of Physical Medicine and Rehabilitation
2005; 84 (3): 218.
Buttaci CJ, Foye PM, Stitik TP
University of Medicine and Dentistry of New Jersey, New Jersey Medical School, in Newark, New Jersey, United States. tailbonedoctor.com/
Full paper (Poster)
To determine the efficacy of fluoroscopic guided ganglion impar blocks in the management of coccydynia.
Case series reviewing the results from five patients encompassing 19 procedures.
Five patients between the ages of 28 and 76 years were treated with fluoroscopic guided ganglion impar blocks to manage their coccyx pain after more conservative measures including oral medicines and orthotic appliances failed to provide adequate relief. The etiology of the pain included falls and motor vehicle accidents without evidence of fracture, postpartum onset and possible congenital anomalies. The diagnosis of coccydynia was based on their history, location of pain and response to previous diagnostic and therapeutic procedures.
All five patients experienced some relief in their symptoms. The percentage of relief per injection varied from 20% to 75%. The duration of the significant analgesia varied from a few hours to 3 months.
These results suggest that the application of 0.5% bupivacaine to the impar ganglion provides significant, albeit temporary relief from intractable coccyx generated pain. The ganglion Impar (ganglion of Walther) is a solitary retroperitoneal structure that represents the termination of the paired paravertebral sympathetic chains and provides sympathetic innervation of the perineum. The use of ganglion impar blocks to relieve pain from neoplastic involvement of perineal structures is a well documented technique. To our knowledge, this is the largest study confirming the success of these fluoroscopic guided blocks in managing coccydynia. These results may encourage the investigation of radiofrequency ablation or other potentially permanent procedures to manage coccydynia.