Journal of Bone and Joint Surgery (British Volume)
1954 36: 142
Presented at the British Orthopaedic Association Annual Meeting, 1953
Mr H. J. Richards (Oswestry) reviewed the possible causes of coccydynia in the light of a study of 102 cases. A history of injury was present in less than half the cases. Infection and neoplasm were occasional causes but could not explain the majority. Psychogenic factors were secondary rather than primary.
He believed that in many cases coccydynia was caused by a central prolapse of one of the lower lumbar intervertebral discs. He supported this hypothesis on theoretical grounds and by clinical observation. Thus forty out of 1,000 patients diagnosed as having a disc protrusion complained of coccydynia in association with sciatic pain; and nearly half of the patients with coccydynia had initial low backache or sciatica and most of the remainder later developed similar symptoms. Many patients had gained relief from pain after immobilisation of the lumbar spine in a plaster jacket.
Mr K. I. Nissen (London) expressed strong disagreement with the hypothesis presented. In his experience relief from coccydynia could nearly always be assured by repeated manipulation of the coccyx : excision might be necessary in 5 to 10 per cent of cases. He could not accept the argument that prolapse of an intervertebral disc played a direct part in the etiology. Mr H. K. Lucas (Bristol) supported the concept of root pressure as a cause of coccygeal pain. Mr G. K. Rose (Shrewsbury) had had success with the treatment of coccydynia by plaster jackets.