Coccygeal pain relief after transsacrococcygeal block of the ganglion impar under fluoroscopy: a case report.

Archives of Physical Medicine and Rehabilitation

Volume 84, Issue 9 , September 2003, Page E24

Kuthuru, MR, Kabbara, AI, Oldenburg, PF, Boswell, MV, Rosenberg, SK

University Hospitals of Cleveland/Case Western Reserve University, Cleveland, OH, USA

Abstract

Setting

Tertiary care university hospital.

Patient

A 48-year-old man with coccydynia.

Case Description

The patient, who had multiple sclerosis, presented to our clinic with a 3-year history of coccygeal pain. Pain varied from 5 to 10 on a scale of 10 and was described as a sharp, knife-like, burning, stabbing, and achy pain. Walking, sitting, standing, and bending exacerbated pain. Alleviating factors included using topical capsaicin. The patient tried multiple medications without relief. Poor sleep parameters were noted. Strength was 2/5 on the left and 3/5 in the right lower extremity. Upper-extremity strength was normal.

Assessment/Results

The patient was diagnosed with coccydynia. Fluoroscopically guided ganglion impar blocks were performed on February 4 and Feburary 8, 2002; the blocks resulted in 50% to 60% pain relief. A caudal epidural steroid injection, performed on March 4, 2002, under fluoroscopy, did not provide any relief. Pulsed radiofrequency denervation of the ganglion impar was performed under fluoroscopy on June 20, 2002, with good pain control noted.

Discussion

Ganglion impar, also known as the ganglion of Walther, supplies some innervation for the pelvic and perineal regions, and it was initially blocked by Plancarte in 1990. To our knowledge, its effectiveness for coccydynia has not been published. We present 1 patient who experienced dramatic improvement in his coccygeal pain after blocking the ganglion impar under fluoroscopy. Successful pain control aids rehabilitation. The ganglion impar is the most caudal of the sympathetic prevertebral ganglion and supplies sympathetic fibers to the perineum. It is located anterior to the sacroccygeal junction. Blocking the ganglion impar has demonstrated considerable relief of intractable perineal and pelvic pain. Due to its location, bowel and bladder dysfunction are potential risks. Penetration of the rectum is a potential complication.

Conclusions

Fluoroscopically guided ganglion impar block may offer a safe and effective way of improving coccygeal pain.

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